Say what you will about alternative therapies, but while many are based on some pretty loopy theories, wishful thinking and a whole lot of anecdotal evidence, some may have measurable clinical benefits beyond the all-powerful placebo effect. Homeopathy is not likely one of these. And, as health policy expert Timothy Caulfield writes in Policy Options, simply researching homeopathy in Canadian academic institutions might even be considered unethical.

If that seems a bit extreme, perhaps a brief explainer of homeopathy is in order (I highly recommend the BBC documentary included here if you have time). It’s a type of therapy grounded on the idea that when a substance is introduced in water, then diluted out of it, the water still “remembers” that substance. That “memory” is so strong that the water has therapeutical qualities based on what used to be contained within it. Caulfield points out there is absolutely no scientific basis for this belief. “To believe homeopathy works – or even could work – beyond the placebo effect…is to believe in magic.” Engaging in a study that does not conform to generally accepted scientific principles, he suggests, is in direct contravention of the World Medical AssociationDeclaration of Helsinki, which sets the standard for academic research worldwide. It is unethical, because according to the National Institutes of Health, this kind of scientifically invalid research “is a waste of resources and exposes people to risk for no purpose.”

We’ve all in the unfortunate position where we’ve found ourselves uttering the words, “It must have been something I ate.” But Salon.com’s Lindsay Abrams writes about a new report that suggests certain types of food are more likely than others to make us sick. The Interagency Food Safety Analytics Collaboration (IFSAC) pored through data from 1000 outbreaks going back to 1998 and analyzed the sources of four kinds of food-borne pathogens: Salmonella, E. coli O157, Listeria monocytogenes and Campylobacter.

What they found was perhaps unsurprising but worth repeating nonetheless: that dairy, and particularly raw milk, could be blamed for two thirds of Campylobacter cases; that fruit was the culprit in half of all Listeria cases; Salmonella was found equally among seeded vegetables, eggs, fruit, chicken, beef, sprouts and pork; and E. coli was most often found in beef and row crops such as lettuce. The report is intended as an effort to promote greater food safety and reduce instances of contamination before food reaches supermarket shelves.

Former Daily Show correspondent and current Last Week Tonight host John Oliver may not be taking over his former boss’s job any time soon. But that’s partly because he’s too busy making his own mark over at HBO. Each week, he has used his extraordinarily sharp wit to take down powerful adversaries. And in a recent episode, he turned his attention to perhaps the greatest corporate super villains of all: Big Tobacco.

As it turns out, cigarette manufacturers haven’t been winning a whole lot of battles on this side of the world of late, given the ever-strengthening public health laws that have restricted their business and drastically reduced their customer base. So they’ve turned their attention to the developing world, where smoking rates are higher (and in some cases, growing) and governments are more easily bullied. Philip Morris International is a particularly unscrupulous organization, battling plain packaging regimes and other government restrictions aimed at promoting good health. Oliver’s mix of righteous outrage, absurdist humour and impeccable research make this segment a must-see.

LONDON — Three Austrians have replaced injured hands with bionic ones that they can control using nerves and muscles transplanted into their arms from their legs.

The three men are the first to undergo what doctors refer to as “bionic reconstruction,” which includes a voluntary amputation, the transplantation of nerves and muscles and learning to use faint signals from them to command the hand.

Previously, people with bionic hands have primarily controlled them with manual settings.

“This is the first time we have bionically reconstructed a hand,” said Dr. Oskar Aszmann of the Medical University of Vienna, who developed the approach with colleagues. “If I saw these kinds of patients five to seven years ago, I would have just shrugged my shoulders and said, ‘there’s nothing I can do for you.”‘

He said while some patients might be candidates for a hand transplant, that has its own complications, including having to take anti-rejection medicines for the rest of their lives.

Aszmann and colleagues described the cases of the three men in a report published online Wednesday in the journal Lancet. The men decided on amputation only after having the bionic hand strapped onto their injured hand, to see how the robotic one might function.

For Milorad Marinkovic, 30, who lost the use of his right hand in a motorbike accident more than a decade ago, the bionic hand has allowed him to hold things like a sandwich or bottle of water — and more importantly, to play with his three children.

“I can throw things, but it is harder to catch a ball, because my right hand is still not quite as quick and natural (as my left),” said the Vienna based-clerk.

Dr. Simon Kay, who authored an accompanying commentary and performed Britain’s first hand transplant, said there would always be major limits to bionic hands. He pointed out that the brain has thousands of ways to send messages to the human hand but that a robotic prosthetic can’t handle such complexity.

Milorad Marinkovic holds a glass of water with his bionic arm as he poses for a photograph at his home in Vienna, Austria, Tuesday, Feb. 24, 2015. [AP Photo/Ronald Zak]

“The question is always going to be: How do we get the message from the mind to the metal?” he said.

Patients like Marinkovic, however, have few complaints about the bionic hand, which proved especially popular with his son. When he first got the device, his son, then 4, would put on the bionic hand and proudly walk around with it, telling the other kids in his kindergarten class that “my father is a robot.”

Marinkovic says using his bionic hand is nearly as natural as using his uninjured hand.

“I can do almost everything with it. I just don’t have any feeling in it.”

An unrelated study published last year gave patients some feeling in a prosthetic hand by relaying signals to the brain in a temporary experiment and other replacement hands can do things like grip objects but are controlled externally.

]]>http://o.canada.com/health/a-helping-hand-3-austrian-men-first-to-get-bionic-reconstruction-of-hands-after-amputations/feed1Austria-Bionic-Hands.jpgtheassociatedpresscanadaMilorad Marinkovic holds a glass of water with his bionic arm as he poses for a photograph at his home in Vienna, Austria, Tuesday, Feb. 24, 2015.Milorad Marinkovic holds an egg with his bionic arm with his bionic arm as he poses for a photograph at his home in Vienna, Austria, Tuesday, Feb. 24, 2015.Mending young mindshttp://o.canada.com/life/parenting/mending-young-minds
http://o.canada.com/life/parenting/mending-young-minds#commentsTue, 24 Feb 2015 12:00:39 +0000http://o.canada.com/?p=592636]]>Ann Douglas’s uber popular parenting books have helped a generation of Canadian families keep their wits while raising their kids. But even a pro like Douglas felt “like a completely incompetent parent” when each of her four children struggled with a mental-health illness.

“At times, I felt as though our lives were falling apart. And I was about to nosedive into a deep depression,” says Douglas, who has bipolar disorder.

Perhaps the scariest time for Douglas was when her daughter, Julie, overdosed in a misguided attempt to escape the agony of adolescent depression. Sitting at her hospital bedside about 12 years ago, Douglas confronted the reality that “there weren’t any classes I could take to tell me how to keep my teenage daughter safe from herself.”

Douglas’s experience, which she recently opened up about, is a reminder that none of us are immune to the fear, confusion and isolation brought on by mental illness. And we can only imagine how much more acute these feelings are if you’re a parent whose child or teen is suffering.

The core of our work is empowering young people. And we’ve championed mental health by welcoming Olympic athlete Silken Laumann, sports broadcaster Michael Landsberg and Lieutenant-General Roméo Dallaire to We Day, where they’ve touched thousands of students with their first-hand experiences of depression and post-traumatic stress disorder.

With her new book Parenting Through the Storm, Douglas becomes an important voice in the national conversation on youth mental health. In a recent conversation, we asked the author how parents can best be advocates for their children’s mental health.

Her advice is a potential lifebuoy for those beginning to navigate their way through uncertain waters.

A 2011 RBC study shows it takes two years from when parents first see signs of a suspected mental illness to when their child is diagnosed.

This is why Douglas advises parents to check out their young person’s symptoms “the moment your radar goes off, and get on a waiting list.”

When your child gets a diagnosis, help them to see it “as something that empowers not limits them,” says author Ann Douglas.

While wait times for an assessment and treatment can be frustrating, she encourages families to make the most of this time. “Ask doctors, teachers and other parents for information on support groups in your community.”

When your child gets a diagnosis help them to see it “as something that empowers, not limits, them,” says Douglas. Your family now has answers that will help guide treatment and that you can share with teachers so they can best support your child.

Good sleep is critical to good mental health, along with eating well and exercise. Fotolia

Douglas also advocates families practise self-care. There’s so much research that shows exercise, good sleep, eating well and practices like meditation are great balms for our mental health. And we don’t need a diagnosis or a prescription to follow them.

You can try a yoga class with your grade schooler, says Douglas. Or if your teen has a supportive friend, offer to take them to a rock-climbing gym.

At our leadership camps, we’ve learned the value of talking to young people about their passions. Perhaps, it’s one-on-one guitar lessons that curb your teen’s anxiety. Inquire, listen and then take their lead.

If you feel your child or teen is up to it, encourage them to be their own advocate. For example, Douglas says parents can ask their kids to speak at school or doctor’s meetings about their mental health, and brainstorm about possible solutions to obstacles, such as not wanting to go to gym class.

More than anything, Douglas wants families to hold onto hope and know “you are resilient.” Her now grown children — and the author, herself — are thriving with the challenges life has thrown them. “We have come so far,” says Douglas. “We have been strengthened by the storm.”

This is our wish for every child and family living with mental illness.

Brothers Craig and Marc Kielburger founded a platform for social change that includes the international charity Free The Children, the social enterprise Me to We and the youth empowerment movement We Day.

]]>http://o.canada.com/life/parenting/mending-young-minds/feed0teenage_depressioncraigkielburgerparenting_through_the_stormGood sleep is critical to good mental health.Surviving cancer, living with its legacyhttp://o.canada.com/health/women/surviving-cancer-living-with-its-legacy
http://o.canada.com/health/women/surviving-cancer-living-with-its-legacy#commentsFri, 20 Feb 2015 20:45:52 +0000http://o.canada.com/?p=589441]]>Beyond battling and surviving cancer, we’re less inclined to talk about the challenges that lie ahead for those who either find themselves cancer-free or have beaten the disease back to a chronic state. Many survivors would tell you how they view their bodies differently. Some may lament the legacy of their disease. And often there’s not much spoken about the struggle that exists in the realization that survivors’ lives – and their bodies – will never be the same again.

Coping with this reality, and perhaps even celebrating it, is key to moving forward. It’s not just about surviving; it’s about finding a new life after cancer.

Cathy’s struggle

In 2007, at age 45, Cathy Spencer went for what she thought was a routine mammogram.

“[The radiologist] stopped me and they said, ‘You have calcifications in your left breast,'” says Spencer. “And then I said, ‘Does that have anything to do with the little lump up here on my collarbone? Or this lump that seems to be growing underneath my armpit?'”

The radiologist sent her back to her doctor, who subsequently sent her for further testing before she ultimately received her diagnosis: she had stage 2-B breast cancer.

Cathy would have to undergo eight rounds of chemotherapy; however, upon finishing the seventh round, she started to notice herself feeling a bit off. Dazed, perhaps.

“I couldn’t follow a movie on TV,” she recalls. “I went grocery shopping and stood in the wrong lineup. I went to buy blueberry yogurt and came home with apricot yogurt. Things were shifting, and I wasn’t doing anything logical.”

Further testing revealed a 2.5 centimetre mass on her brain. Her cancer had become metastatic.

After a craniotomy to remove the tumour, Cathy underwent 10 rounds of brain radiation and 35 rounds of breast radiation. Ultimately, she would be put on a drug, Herceptin, that proved effective at beating back the cancer – not completely, but to a point where she is able to manage her illness and keep it at bay.

Cathy Spencer poses with her husband in a 2014 photo. [Supplied photo/Cathy Spencer]

Now 52 years old, Cathy is living with cancer. She is not cancer free. She still carries the scars of a life-threatening illness: her hair never fully grew back after all the rounds of chemo. And while the tumour in her brain was successfully removed, she lives with complications from the surgery.

“I have part of my memory that’s lost,” she says. “And I walk like a drunken sailor.”

Her experience speaks to a little-discussed truth faced by cancer survivors (and those like Cathy, who live with it through regular medication regimens): even if you beat cancer, it leaves its mark on your body. You can move on from it – and many do – but it changes your outlook. It changes the way you view yourself, both inside and out. It changes your relationship with your own body.

Cathy even wrote a poem about it. Aptly titled “Dear Body,” it’s essentially a letter to herself in which she recalls her experience, through all the surprises, resolutions and negotiations she has made with herself, with her body, in learning how to live with her illness.

“Dear Body” – a poem by Cathy Spencer

Dear Body Wow you tricked me. Dear Body We have no Family History of Breast Cancer. Dear Body our first mammogram and POOF calcifications in my left breast. Dear Body a lump on my collar bone. Dear Body now it’s in my left armpit? Dear Body my Lymph Nodes?? Dear Body Alarming and travelling Why Me? Dear Body Help Me You’re entering my Brain !!! Dear Body what have you done? A Craniotomy? Dear Body just let me live. Dear Body I am stage 4 look what you have done! Dear Body what is Metastatic Breast Cancer? Dear Body I have a Beautiful Family. Dear Body take the Chemo the Radiation and Surgery. Dear Body use the drugs and make me whole again. Dear Body THANK YOU I am 51 now and still here 7 years Later. Dear Body my family has grown and I am still whole. Dear Body I will advocate for Metastatic Breast Cancer. Dear Body I am stronger Dear Body I have always loved you Dear Body Thank You

In survival, forging a new identity

Many other survivors of cancer live with the scars of radical surgeries – in the case of breast cancer, lumpectomies and mastectomies. Others have radiation scars, their skin forever changed from the treatments. Reconstructive surgery is available; still, for most survivors, their bodies – and their relationship with their own bodies – will be forever changed.

It’s in accepting this reality, even celebrating it, that Noel Franus has found his calling. He’s the founder of P.ink (or Personal Ink), an organization that provides tattoos for breast cancer survivors.

The idea originated a few years ago, when Franus’ sister-in-law Molly Ortwein found out she had cancer and would have to undergo a double mastectomy. She had learned that reconstructive surgery was limited in what it could provide: doctors told her she wasn’t going to get her nipples back.

“She was really frustrated with the idea that the doctor said he could sort of tattoo one on,” recalls Franus, “And what she found is it’s usually not the case that doctors are as skilled as artists. Imagine that?”

She asked the family instead for tattoo ideas. “She felt, well, if I can’t get back what I had before, why don’t I try to re-think what should have been there in the first place?” says Franus.

It was from this experience that Franus, a designer for the advertising agency CP+B in Boulder, Colorado, came up with the idea for P.ink, a resource for breast cancer survivors that provides tattoo design inspirations, and connects them with a roster of qualified, trusted artists. The first P.ink Day, which has now become an annual event, was held in Brooklyn on October 10, 2013, and matched 10 artists with 10 survivors. The 2014 event involved 37 artists and 38 survivors in 12 cities across North America. In addition, they have created a fund that pays tattoo artists to do this work on a year-round basis, connecting them with a list of survivors in both the United States and Canada.

Franus attributes P.ink’s success to the empowering effect it has had on survivors. It has allowed them, in a sense, to reclaim their bodies from the effects of their cancer. It puts them back in control.

“You get to design essentially what the effects of breast cancer look like on you,” says Franus, “instead of breast cancer determining what you’re going to look like and what you’re going to live with.

“There are a lot of survivors – many women who when they look in the mirror, they’re not happy with what [their cancer] has left them with. It might be a scar, they’re proud to survive. But nobody’s really focusing on the quality of life in this way, after you’ve actually beaten breast cancer and the effects of it still linger. They’re happy to have a bit of say in that.”

In fact, Franus finds there’s a profound sense of pride among many of these survivors, coming from what might be described as the forging of a new, post-cancer identity.

“They feel like they can make friends with the mirror again,” he says. “These people, [who were] in some cases very conservative, now want to parade around the block topless. Many of them have a new-found sense of devil-may-care because they’re so proud of what they look like, and so rather than concealing themselves before, sometimes usually out of shame, now they’re more than happy to show their new selves to people.”

If your typical February night involves searching the kitchen for a snack to lift your spirits, you are not alone. This is prime winter-blues season, the time of year when many of us are plagued with that lethargic feeling that’s like a dark curtain over our mood. An estimated 14 per cent of Americans are affected by it — and about another 6 per cent have the more severe condition called seasonal affective disorder (SAD).

But while the typical comfort-food grab that lands you on the sofa with a bag of cookies may provide temporary relief with a rush of sugar into your bloodstream, the following crash only drags you down further. And the inevitable weight gain from eating that way over time makes you burrow deeper into the doldrums.

As a rule, it is best not to turn to food as a way to cope with your emotions — it usually doesn’t help, it just distracts you from dealing with them. But in the case of the winter blues, there is a bona fide food-mood connection, and eating certain foods could maximize your chance of feeling better as you wait for the spring thaw.

Eat like an Icelander

One clue for beating the blahs this time of year can be found in Iceland. It has an extremely dark winter, yet the people there have virtually no seasonal affective disorder. When scientists looked into why, they pinned it on the fact that Icelanders have one of the highest per-capita fish consumptions of any population, more than quadruple that of Americans. That means they are getting a lot of omega-3 fats, which have a critical role in brain health and documented mood-stabilizing and anti-depression effects.

Take-home message: Herring makes you happy. Actually, herring and other fatty fish such as salmon, trout and sardines are all top sources of omega-3s. A mere three-ounce portion of salmon provides a day’s worth of the essential fat, for example. Other types of seafood, such as tuna, flounder and shrimp, have these good fats as well, so whatever kind you enjoy, aim to get at least two seafood meals a week. You can also get omega-3 fats from flaxseed, walnuts and green leafy vegetables, but the type they contain (called ALA) is not as potent as that in fish (DHA and EPA).

The sunshine vitamin

Fish is also the No. 1 food source of vitamin D, called the sunshine vitamin because our bodies are able to make it when exposed to the sun’s rays. Low levels of this essential nutrient are linked to depression and connected to seasonal affective disorder. In the winter, not only is there less sun, we also tend to hunker down inside, giving our bodies little chance to make the vitamin. After several weeks, especially if we are not eating well, our stores can become depleted, and that may affect our mood.

Getting outside, even for a little while and even if it’s cloudy, could make a difference in your body’s ability to generate vitamin D. Not to mention, there is plenty of evidence that walking outdoors and being active in winter improves one’s sense of well-being.

But it’s also important to focus on eating more vitamin-D-rich foods. That three-ounce piece of salmon so chock-full of feel-good fat also provides the full daily value for vitamin D, and other fish does the same. Milk, which is fortified with the nutrient, is another excellent source, and egg yolk has a good amount, too.

Carbohydrate connection

One main symptom of SAD is craving carbohydrates, because they trigger the release of serotonin in the brain and bring on a feeling of calm contentment. But rather than fall into the snack-attack trap, you can take advantage of this effect in a healthy way by focusing on good-for-you carbohydrates in smart portions, especially in the evening when the bluesy symptoms tend to be the strongest. Rather than just going on an open-container carb bender, plan and portion out an evening snack of, say, a sliced pear sprinkled with cinnamon, a small bowl of popcorn or some whole-grain crackers with jam to give you the lift you need, in a healthy way.

Nearly 25 years ago, the National Cancer Institute declared that women with early-stage breast cancer could be spared mastectomies. The institute acted after studies found that breast removal offered no survival benefits over removing just the lump and following up with radiation treatments.

This caused the pendulum to swing hard away from mastectomies, from a rate of nearly 100 per cent in the 1980s for patients with small tumours that had not spread beyond the breast or surrounding lymph nodes to less than 40 per cent today.

Now, though, the pendulum is starting to swing back in a surprising way.

Breast surgeons have recently seen a surge in patients with small nonaggressive tumours who opt to have one or both breasts removed (including the one that’s cancer-free) rather than removing just the malignant lump in one, called a lumpectomy.

In a study published recently in the journal JAMA Surgery, researchers from Vanderbilt University Medical Center examined a national surgery database of 1.2 million patients with early-stage breast cancer and found that the percentage of women who opted for a mastectomy over a lumpectomy increased from 34 per cent to 38 per cent from 2003 to 2011. The rates of women having double mastectomies when they only had disease in one breast jumped from 1.9 per cent in 1998 to 11.2 per cent in 2011.

While studies haven’t focused on the reasons women with early breast cancer are opting to have the breast removed, a half-dozen women who were interviewed about their decision named fear of recurrence as the biggest factor and spoke of the relief they felt afterward. They didn’t want to deal with the anxiety of twice-yearly mammograms and findings that might result in further imaging, biopsies and uncertainty. One of these women, a radiologist, worried that mammograms would miss a subsequent cancer until it had grown large enough to spread. Others said they were concerned that radiation treatments administered after a lumpectomy might cause additional health troubles, since cumulative effects of it can damage the heart, lungs and surrounding bones — and even, rarely, spur new cancers.

“The stigma that was once associated with mastectomy in our mother’s and grandmother’s era has definitely changed,” said Eleni Tousimis, director of the Ourisman Breast Health Center and chief of breast surgery at MedStar Georgetown University Hospital in Washington. Instead of needing a giant incision to remove muscle along with breast tissue, surgeons now make a small incision near the bra line to remove just breast tissue, she said, “with reconstruction results that can look similar to breast augmentation.”

She pointed to recent improvements in breast reconstruction techniques — improvements that spare the nipple and areola — and more widespread insurance coverage for the surgery as helping to tip the balance toward mastectomies.

And then there is the growing number of celebrities who have had the operation — and who continue to be outspoken about their decision. No one can dispute that actress Angelina Jolie — who announced last year that she had preventive mastectomies after she was found to carry a breast cancer gene mutation — looks spectacular after her reconstruction surgery, an image that some women may conjure up when weighing their surgical options, said Mehra Golshan, director of breast surgical services at the Dana-Farber Cancer Institute in Boston.

E! talk show host Giuliana Rancic and comedian Wanda Sykes spoke passionately about their decisions to have double mastectomies for early-stage breast cancer; both have said that they felt the more radical surgery gave them a better shot at survival — a notion not proven in clinical trials.

Doctors’ changing attitudes may have also contributed to the pendulum swing. “We had gotten to a point where lumpectomy was the default operation that surgeons more or less dictated to a patient,” said breast surgeon Shawna Willey, vice chairman of clinical affairs in the surgery department of MedStar Georgetown. “Now we offer breast conservation [lumpectomy] as a choice, but not one that is forced down a woman’s throat.”

After being diagnosed with breast cancer last October, Mary Zambri, 50, of Bethesda, Md., was told by her doctor that she was the perfect lumpectomy candidate because her tumour was only about an eighth of an inch in diameter. Her mother urged her not to do a mastectomy. Her brother, however, urged her to do it because their father had had breast cancer and been successfully treated with a mastectomy decades earlier.

Although Zambri did not have a gene mutation that predisposes women to breast cancer, she was convinced there was a hereditary component to her cancer that would increase her risk of having another breast tumour. “Sometimes these lumps come back,” she said. “I have four young daughters and wanted peace of mind that I was doing everything I could so my daughters would continue to have a mom.”

After doing an hour of yoga in her home studio, she knew she was going to have a double mastectomy, even though one breast was completely fine. “I made the decision on my own terms and never doubted it for a second. It’s the complete right decision.”

Some experts believe that treating tiny, low-risk tumours with a draconian treatment — recovery that can take months, rather than lumpectomy’s days — is a large step backward. “I spend a lot of time with patients discussing the drawbacks of a mastectomy, like the pain of reconstruction, the loss of sensation in their breasts and how the larger surgery won’t prevent any potential spread to their liver or lungs,” Golshan said.

He and other breast surgeons tick off well-worn findings from multiple clinical trials conducted in the 1980s: Regardless of whether a woman with early-stage breast cancer has a mastectomy or a lumpectomy with radiation, she has the same overall survival chances, with no difference in her risk of cancer spread to distant organs. Radiation treatments administered with lumpectomies carry only a slight risk of long-term damage to the surrounding heart, lungs and bones.

While many women assume that a double mastectomy means they’ll never have to worry about breast cancer again, Tousimis emphasizes to her patients that surgeons cannot remove 100 per cent of breast tissue during mastectomies since a thin layer of tissue remains attached to the skin. While the risk of developing a new breast tumour after the surgery is remote, it’s not zero, she said.

About 5 to 6 per cent of women with lumpectomies eventually develop another breast tumour, compared with 1 to 2 per cent of those who have either a single or double mastectomy.

While that difference is considered modest in the medical community, it can loom large for patients calculating the emotional toll that a second round of breast cancer would exact. “A lot of patients base their treatment decision not on statistics but on what their friends with breast cancer have gone through,” Golshan said.

“The anxiety factor comes up a lot in discussing surgical options with patients,” said Bonnie Sun, an assistant professor of surgery at Johns Hopkins School of Medicine. Patients don’t want to have additional biopsies, multiple imaging and multiple surgeries down the road.

Phillipa Hughes, 46, first considered having a lumpectomy 18 months ago, when she was diagnosed with a small breast tumour, but she opted for a double mastectomy with reconstruction after speaking to other breast cancer patients through a support network.

“One woman told me she had three lumpectomies before she threw in the towel to have a mastectomy,” she said. Tousimis, her surgeon, told her that 15 to 20 per cent of women who undergo lumpectomies need to have a second surgery within days of the first one to remove more breast tissue after a pathologist finds cancer cells have spread beyond the excised tumour and excised tissue.

Hughes, who lives in Washington, was also put off by the radiation required after a lumpectomy, which seemed, she said, like a horrible part of the treatment. Her age was also a consideration: She foresaw decades of anxiety-ridden mammograms looming before her. “I decided on the mastectomy,” she said, “mostly because I never wanted to have to worry about the possibility of breast cancer again.”

Hughes has no regrets about her year of multiple surgeries needed to first get rid of the cancer and then prepare the breast area for implants, and the painful recuperation. “My breasts look pretty darn good,” she said. “They’re perpetually perky.”

Ann Scharf, a radiologist at Bay Health Medical Center in Dover, Del., said she chose to have a double mastectomy last October because she didn’t want to spend the rest of her life worrying that she had a tumour that wouldn’t be detected on a mammogram; the 54-year-old detected her half-inch tumour on a self-exam soon after her mammogram came back normal.

“My surgeon didn’t present mastectomy to me as an initial option,” Scharf said, “but she didn’t try to talk me out of it.”

Breast surgeons are encouraged by the National Cancer Institute and by groups that accredit cancer centers to offer breast-conserving lumpectomies to all patients with an early stage of the disease. The American College of Surgeons’ National Accreditation Program for Breast Centers asks hospitals that it accredits, including MedStar Georgetown and Scharf’s hospital, to aim to perform lumpectomies in at least 50 per cent of patients who are eligible.

Scharf worries that such a benchmark may lead surgeons to pressure patients out of concern that too many mastectomies might put their hospital’s accreditation in jeopardy. But David Winchester, medical director of cancer programs at the American College of Surgeons, said the rate reflects the current national trend. “Our surveyor might intervene if a hospital comes in with an 80 per cent mastectomy rate, which we consider extreme,” he said.

]]>http://o.canada.com/health/women/mastectomies-gain-favour-over-lumpectomies/feed0In making her decision to have a double mastectomy, Phillipa Hughes said she “never wanted to worry about the possibility of breast cancer again.”washingtonpostcanadacomA good way to prevent cancer: Eat your fruits and vegetableshttp://o.canada.com/health/diet-fitness/a-good-way-to-prevent-cancer-eat-your-fruits-and-vegetables
http://o.canada.com/health/diet-fitness/a-good-way-to-prevent-cancer-eat-your-fruits-and-vegetables#commentsWed, 18 Feb 2015 16:39:42 +0000http://o.canada.com/?p=592349]]>By Suzanne Allard Levingston

The best advice for cancer prevention is to do what your mom always told you: Eat your fruit and vegetables, get some exercise and keep that weight in a healthful range, says Stephen Hursting, a professor of nutrition at the University of North Carolina at Chapel Hill.

Here are recommendations from nutrition experts for a balanced diet that will serve you well for avoiding a variety of diseases.

— Eat lots of leafy, colourful fruit and vegetables. They’re full of antioxidants — substances that help repair cell damage and may help prevent some kinds of cancer. These foods also have anti-inflammatory components that might play a role in fighting cancer.

Red, orange and yellow pigments of an antioxidant class called carotenoids are thought to be particularly important and are found in such foods as carrots, sweet potatoes and peppers. Tomatoes have shown some benefits against prostate cancer, says Walter Willett, chair of the Department of Nutrition at the Harvard School of Public Health.

— Choose whole grains. These fibre-rich foods, such as brown rice and bulgur, are essential for a healthy gut and healthy gut bacteria. Gut bacteria and the digestive tract play an important role in the immune system, which may be implicated in some cancers, says Marian Neuhouser of the Fred Hutchinson Cancer Research Center. Whole-grain foods will help you feel full and avoid overeating that can lead to excess weight and obesity and related cancers.

— Opt for lean protein. Find protein in foods such as nuts or beans and in fish or lean meats. Limit red meats. Avoid processed meats. The American Institute for Cancer Research recommends aiming for a plate filled one-third or less with animal protein, two-thirds or more with fruit, vegetables and whole grains.

— Use unsaturated vegetable oils for food prep and cooking. While not identified as relating to cancer, these are good for fighting heart disease and type 2 diabetes, Willett says.

— Eat low-fat or nonfat dairy products.

— Limit alcohol. Whereas alcohol is thought to have some small positive effect against heart disease, the same is not true for cancer. Experts recommend moderation.

— Be mindful of your pattern of eating over time and be aware of the size of your plate and portions.

— Eat wisely away from home, too. When dining out, remember moderation — especially since most Americans now eat out almost half the time, Neuhouser says.

— Limit empty calories. Consider sugary sodas or sports drinks on par with cupcakes. You wouldn’t eat a cupcake three times a day, every day or even three times a week, Neuhouser says. Empty calories point you toward overweight and obesity and related diseases including cancers.

KITCHENER, Ont. — The federal government has a year to come up with new legislation after a unanimous Supreme Court of Canada ruling on Feb. 6 in favour of physician-assisted death. In a decision that went beyond the expectations of even committed activists, the high court said a new law must recognize the right of consenting adults enduring intolerable suffering to seek medical help to end their lives. Reporter Colin Perkel of The Canadian Press spoke to right-to-die activist Linda Jarrett, 66, who has multiple sclerosis and has been reflecting at her home in Kitchener, Ont., on what the decision means for her.

CP: Initially, when the Supreme Court decision was announced, you seemed more subdued than exuberant. Tell me about that.

L.J.: It just threw me for a loop. I was so taken aback. I didn’t even know how to react. I didn’t really understand that: ‘Linda, this means that instead of thinking about how you’re going to hasten your own death, you can relax now, enjoy life, and not worry so much about it.’ That took a while to sink in.

CP: Now that it has sunk in, you say you feel relief?

L.J.: Before this ruling, I was faced with the possibility that I would almost certainly have to prematurely end my life while I was still physically capable of doing so, because I don’t want anyone going to jail for helping me die. The relief is I’m not going to start now looking for which drugs to take or which helium bag to use. I can just enjoy the quality of life that I have. When that quality is not one that I can accept, there is a viable option now.

Linda Jarrett is pictured in her home in Kitchener, Ont. , on Tuesday, February 10, 2015. Jarrett, who suffers from multiple sclerosis, is one of the advocates who celebrated, and intends to take advantage of, The Supreme Court’s recent ruling that Canadian adults have the right to a doctor’s help in dying. [The Canadian Press/Chris Young]

CP: Does the ruling put pressure on people to exercise the new choice of physician-assisted death?

L.J.: That’s fearmongering, the slippery slope, that whole thing. That drives me insane. I would not for one minute expect anyone else to make the choices I make. The legislation that will hopefully come out of this will respect the individual’s right to choose.

CP: Isn’t having the choice a bit scary?

L.J.: I’ve already pictured in my mind for the last couple of years when I would like to leave this life. I will know. I’m not afraid of dying. I am afraid of the kind of life I would have to live until I die.

CP: Can you paint that picture of when that might be?

L.J.: I have been a very independent, active person. It is my wish that I don’t spend the final months or years of my life in a long-term care facility. That’s a very real possibility for someone like me. Now, I could ask for a physician-assisted death before I endure the indignities that I don’t want to be remembered for. Of course everyone’s sad at the moment of death. But I want all of my family and friends to think, ‘She did it her way. Hooray for Linda!’ That would bring me so much joy that the thought of death doesn’t bother me.

This interview was condensed and edited.

Linda Jarrett is pictured in her home in Kitchener, Ont. , on Tuesday, February 10, 2015. Jarrett, who suffers from multiple sclerosis, is one of the advocates who celebrated, and intends to take advantage of, The Supreme Court’s recent ruling that Canadian adults have the right to a doctor’s help in dying. [The Canadian Press/Chris Young]

]]>http://o.canada.com/health/ms-sufferer-linda-jarrett-reflects-on-supreme-court-right-to-die-ruling/feed0Scoc-Assisted-Dying-20150213.jpgthecanadianpressLinda Jarrett is pictured in her home in Kitchener, Ont. , on Tuesday, February 10, 2015. Jarrett, who suffers from multiple sclerosis, is one of the advocates who celebrated, and intends to take advantage of, The Supreme Court's recent ruling that Canadian adults have the right to a doctor's help in dying.THE CANADIAN PRESS/Chris YoungLinda Jarrett is pictured in her home in Kitchener, Ont. , on Tuesday, February 10, 2015. Jarrett, who suffers from multiple sclerosis, is one of the advocates who celebrated, and intends to take advantage of, The Supreme Court's recent ruling that Canadian adults have the right to a doctor's help in dying.THE CANADIAN PRESS/Chris YoungThis week in health: Vaccination and measles, discussed and discussed againhttp://o.canada.com/health/this-week-in-health-vaccination-and-measles-discussed-and-discussed-again
http://o.canada.com/health/this-week-in-health-vaccination-and-measles-discussed-and-discussed-again#commentsFri, 13 Feb 2015 17:14:57 +0000http://o.canada.com/?p=591380]]>Canada.com Health takes a look at a few stories you may have missed this week.

Jennifer Hibben-White’s infant son, Griffin, has been quarantined since February 9 for fear that he may have contracted measles. [Jennifer Hibben-White]

You don’t want to get a mom angry. And when Pickering, Ontario’s Jennifer Hibben-White discovered that her infant son, only 15 days old at the time, might have been exposed to measles in a doctor’s waiting room, she was both scared and furious. Her son was to be quarantined until February 17, forced to wait the duration of the 21-day incubation period for measles just to determine whether he was actually infected. She took to Facebook to mete out an essay’s worth of verbal punishment.

“If you have chosen to not vaccinate yourself or your child, I blame you,” she said of her son’s situation. “You have stood on the shoulders of our collective protection for too long. From that high height, we have given you the PRIVILEGE of our protection, for free. And in return, you gave me this week. A week from hell. Wherein I don’t know if my BABY will develop something that has DEATH as a potential outcome.”

What we’re seeing now, Offit says, is the result of certain communities with low vaccination rates that have become vulnerable. It is, however, but a fraction of the effect a disease like measles might have if there were a more widespread and drastic drop in vaccination rates – if, say, everyone took advantage of the philosophical and religious exemptions that exist in many jurisdictions. “It would look like what it used to look like,” says Offit, “which is to say, every year, 48,000 people would be hospitalized with measles and 500 would die. There would be people who would have subacute sclerosing panencephalitis, which is a chronic measles infection of the brain and is essentially a death sentence.” And those consequences would be just the tip of the iceberg.

Luke Tanner, 7, receives the combined Measles Mumps and Rubella (MMR) vaccination at a drop-in clinic at Neath Port Talbot Hospital near Swansea in south Wales on April 20, 2013. [GEOFF CADDICK/AFP/Getty Images]

As evidenced in Jennifer Hibben-White’s Facebook post featured above, there’s a lot of fear and anger around the discussion of vaccination in the wake of the latest measles outbreak. And while many are pointing fingers at the anti-vaxxers for making us vulnerable to preventable diseases, one Ottawa psychologist is pleading for a more civil approach to our discussion of this issue. While a strong supporter of vaccines, he has become concerned about the importance of being able to speak to the anti-vaccination crowd without screaming and pointing fingers.

“We need to examine how people develop and maintain anti-vaccination beliefs and attitudes,” writes Roger Covin in an article for The Huffington Post. “To simply say they are ‘ignorant’ and move forward is itself an anti-science and impractical way of handling the issue. This problem will not get solved by shouting on Twitter. If we can figure out how people are developing their beliefs and attitudes, then we can better understand the cause.”

]]>http://o.canada.com/health/this-week-in-health-vaccination-and-measles-discussed-and-discussed-again/feed0measles_patientdavidkatesJennifer Hibben-White's infant son, Griffin, has been quarantined since February 9 for fear that he may have contracted measles.Luke Tanner, 7, receives the combined Measles Mumps and Rubella (MMR) vaccination at a drop-in clinic at Neath Port Talbot Hospital near Swansea in south Wales on April 20, 2013. Some experts worry about new vaccination poll despite good support for vaccineshttp://o.canada.com/health/some-experts-worry-about-new-vaccination-poll-despite-good-support-for-vaccines
http://o.canada.com/health/some-experts-worry-about-new-vaccination-poll-despite-good-support-for-vaccines#commentsFri, 13 Feb 2015 13:20:57 +0000https://postmediacanadadotcom.wordpress.com?p=591300&preview_id=591300]]>By Helen Branswell

THE CANADIAN PRESS

A new national poll that mines attitudes toward vaccinations suggests support for these disease prevention tools remains relatively high in Canada.

But if you look beyond the over-arching numbers — nearly nine out of 10 people polled believe vaccination protects against disease — it contains figures that hint that support is less than optimal and potentially softening, said Dr. Kumanan Wilson, a researcher who has studied the phenomenon of vaccine rejection.

“If those numbers drop any lower, we’re starting to get into worrisome range. And the trend doesn’t seem to be in the right direction,” said Wilson, a physician at the Ottawa Hospital.

The online poll was conducted by the Angus Reid Institute, a non-profit group that paid for the poll itself. It is based on the views of 1,509 Canadian adults who answered questions between Feb. 9 and 11.

The polling industry’s professional body, the Marketing Research and Intelligence Association, says online surveys cannot be assigned a margin of error as they are not a random sample and therefore are not necessarily representative of the whole population.

The poll comes at a time when the debate over vaccination is heated, with measles outbreaks in Quebec and Ontario and a large outbreak in the United States that was sparked by exposures at California’s Disneyland theme parks.

Adults 55 and older who took part in the survey were strongly pro-vaccine and tended also to support making vaccination mandatory for children to enter school. But younger adults seemed more ambivalent about these tools, which are widely credited as one of medicine’s greatest advances.

Nine per cent of respondents in the 18-to-34 year old range described themselves as vaccine opponents and 26 per cent in that age group classified themselves as being on the fence. For respondents aged 35 to 54, those figures were five per cent and 16 per cent respectively.

A new national poll that mines attitudes toward vaccinations suggests support for these disease prevention tools remains relatively high in Canada. But if you look beyond the over-arching numbers — nearly nine out of 10 people polled believe vaccination protects against disease — it contains figures that hint that support is less than optimal and potentially softening, said Dr. Kumanan Wilson, a researcher who has studied the phenomenon of vaccine rejection. [The Canadian Press/Chuck Stoody]

“What we find broadly overall is that Canadians are saying that vaccines are effective when it comes to preventing disease in individuals and in the community — nearly nine in 10 of them,” she said.

In fact, 88 per cent of respondents agreed vaccines prevent disease for the individual and 86 per cent agreed they prevent disease in the population as a whole. Of the parents among the respondents, 83 per cent said they would definitely vaccinate their own children.

But those percentages hint at support that isn’t sufficient to maintain herd immunity — enough protection in the community so that diseases like measles, mumps and chickenpox are unable to circulate.

“I think the 83 per cent would definitely vaccinate is a concerning number,” Wilson said. “With the strength of science and the benefits of vaccination, you would hope that number would be much higher.”

The numbers in the poll also capture the growing polarization of society on the issue of vaccinations. While 74 per cent of all respondents said it was irresponsible not the vaccinate children, only 56 per cent of respondents who were parents of school-aged kids believed children should be required to be vaccinated to start school.

The poll did not ask whether parents should be allowed to opt out for religious and philosophical reasons, which makes it hard to interpret how firm the support a mandatory vaccination policy actually is, Wilson noted. And he said going the mandatory route would only harden the views of vaccine opponents.

“If you make it mandatory, people will just opt out of the school system,” he said, suggesting they would home school or cluster together and form their own daycares.

“You can’t just make this thing go away. You have to figure out how to communicate with these people. I think that’s the real message here.”

]]>http://o.canada.com/health/some-experts-worry-about-new-vaccination-poll-despite-good-support-for-vaccines/feed0AMC12 0213 Measels 2thecanadianpressA new national poll that mines attitudes toward vaccinations suggests support for these disease prevention tools remains relatively high in Canada. But if you look beyond the over-arching numbers -- nearly nine out of 10 people polled believe vaccination protects against disease -- it contains figures that hint that support is less than optimal and potentially softening, said Dr. Kumanan Wilson, a researcher who has studied the phenomenon of vaccine rejection. A nurse working for Vancouver Island Vaccine loads a syringe with flu vaccine for injection at the Victoria Clipper Terminal in Victoria Saturday, Oct. 23, 2004. THE CANADIAN PRESS/Chuck StoodyQueen’s University professor under fire for anti-vaccine teachings granted leave from coursehttp://news.nationalpost.com/2015/02/09/queens-university-professor-under-fire-for-anti-vaccine-teachings-granted-leave-from-course/
http://news.nationalpost.com/2015/02/09/queens-university-professor-under-fire-for-anti-vaccine-teachings-granted-leave-from-course/#commentsTue, 10 Feb 2015 15:30:46 +0000http://o.canada.com/?p=590331]]>]]>http://news.nationalpost.com/2015/02/09/queens-university-professor-under-fire-for-anti-vaccine-teachings-granted-leave-from-course/feed0torcolcacci-melodypostmedianews1Toronto’s measles count rises to six with report of infected adulthttp://o.canada.com/news/torontos-measles-count-rises-to-six-with-report-of-infected-adult
http://o.canada.com/news/torontos-measles-count-rises-to-six-with-report-of-infected-adult#commentsFri, 06 Feb 2015 21:35:58 +0000https://postmediacanadadotcom.wordpress.com?p=589668&preview_id=589668]]>By Helen Branswell

TORONTO — Public health officials in Toronto say the city’s measles count has risen to six with the diagnosis of another adult patient.

In the past 10 days four adults and two children in Canada’s largest city have come down with the disease.

As well, a woman in the Niagara region southwest of Toronto has also contracted measles.

Toronto Public Health spokesperson Lenore Bromley says the latest person to become infected was born before 1970.

That’s significant because that was before measles vaccine was introduced in Canada.

People born before 1970 are generally assumed to be immune to measles because most children contracted the highly contagious virus in the days before vaccine was available.

Bromley says public health is still trying to figure out how the virus was introduced to Canada, whether there are connections among the cases and whether more cases are going undetected.

But she says to date there are no clear links among any of the infected people.

[]

]]>http://o.canada.com/news/torontos-measles-count-rises-to-six-with-report-of-infected-adult/feed2Measlesthecanadianpressmeasles_toronto_webTop court’s ruling on assisted suicide leaves many questions for doctorshttp://o.canada.com/news/national/top-courts-ruling-on-assisted-suicide-leaves-many-questions-for-doctors
http://o.canada.com/news/national/top-courts-ruling-on-assisted-suicide-leaves-many-questions-for-doctors#commentsFri, 06 Feb 2015 21:14:26 +0000http://o.canada.com/?p=589697]]>Canada’s highest court has left many questions for some of the central players in any future assisted death scheme — the very doctors who will be asked to help put to death adults who have decided life is no longer worth living.

What is “grievous” suffering? Who defines it? What form of “physician-assisted death” would be permitted? Death by a lethal prescription the patient would take herself, or death by lethal injection? Would physicians opposed to medical aid in dying have the right to refuse to even refer a patient seeking assisted death to another doctor willing to perform it?

“We can’t just simply say we’re going to compel physicians to do things that they personally, morally and ethically can’t do,” Dr. Chris Simpson, president of the Canadian Medical Association said in an interview from Yellowknife moments after the historic and unanimous ruling was released in Ottawa. “But at the same time I think we have to respect that society now has a different view on this. . . . The Supreme Court of Canada has ruled patients have a right to equitable access (to doctor-hastened death) and it’s up to us to figure out how to achieve that.”

In its historic and unanimous ruling, the Supreme Court said it would be up to physicians’ colleges, Parliament and the provincial legislatures to craft a comprehensive assisted death regimen for people experiencing physical or psychological suffering. The court, however, didn’t say whether it would apply to people with mental illness such as depression.

But it did set out some parameters. First, assisted dying would be permitted for competent adults only who could explicitly provide consent — and not people who have been delegated their substitute decision makers should they ever lose the capacity to speak for themselves. “That would appear to set aside concerns of substitute decision makers making the decisions for patients who don’t have competence,” said Simpson, a cardiologist and chief of cardiology at Queen’s University in Kingston, Ont.

The patient would also have to have a “grievous and irremediable medical condition” causing “enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

The court defines a medical condition as an “illness, disease or disability.” But it did not say specifically which conditions would qualify, or where in the course of the illness the person would have to be.

The word “grievous” might also be problematic, said University of Ottawa law professor Amir Attaran. “Grievous is in the eyes of the beholder,” he said.

“The person says, ‘I find this intolerable and I am choosing death over the grievous pain I am feeling.’ Nobody much can define that other than the person who is experiencing it.

“Irremediable is a tougher call. Does that mean an untreatable condition? I think it probably does.”

The person’s condition doesn’t need to be terminal and the court said doctors should be capable of assessing whether someone is competent, and that proper safeguards would protect the vulnerable from “abuse or error.”

The court said declaring the current prohibition against assisted dying constitutionally invalid doesn’t mean doctors would be compelled to provide aid in dying. A doctor’s decision to participate “is a matter of conscience and, in some cases, of religious belief,” the court wrote. But it was more circumspect on whether doctors would be compelled to refer patients to other providers, noting that the charter rights of patients and doctors “will need to be reconciled.”

Doctors are far more deeply divided on assisted suicide than the general public, Simpson said, “and we’ll be looking really carefully for language that protects individual doctors’ right to conscientiously object, and not participate. My early feeling is that there is a lot of reassuring language on that,” he said.

Simpson said the number of patients who would likely be eligible for, or even request assisted death, would be so small, based on experience in other jurisdictions, that there would be sufficient numbers of doctors to provide equitable access for all, “without compelling a large number of doctors to personally participate.” The CMA’s own internal polling suggest about a quarter of doctors in Canada would be willing to help a patient die.

“We need to have a system that balances the right of physicians not to participate, and perhaps not even to refer, but that has to be done in a way that doesn’t impair access for patients who would qualify for this,” Simpson said.

Whatever the final parameters — including what medications would be used, how many doctors would be required, who would have to witness and document assisted deaths — the ruling will provide comfort to Canadians seeking a “humane and dignified” exit from this world, and in their own country, says the family of the woman behind the original lawsuit.

Kathleen (Katy) Carter, of B.C., died five years ago on January in a Zurich clinic, after ingesting a lethal dose of barbiturates. “It was a beautiful death, if that’s possible, for someone who wanted to go,” her daughter Lee told Postmedia News.

Katy Carter’s body was deteriorating rapidly from a painful and paralyzing spinal condition when she died in January 2010, at age 89, surrounded by her family.

Before she died, her mother was unable to go to the toilet on her own, “ to get up, or to do anything herself,” Lee said. “After two-and-a-half years of that she said, ‘I want out. I’ve had a good life, and it’s time for me to go. Lee, will you help me go to Switzerland?” her daughter recalls.

Katy Carter died in her children’s arms. “She literally died with a smile on her face,” Lee’s husband Hollis said.

His transgression — captured in a video gone viral—— makes this guy everyone’s go-to example of setting a poor example for kids. In addition to wishing the glass had been sturdier, we bet Hulk Dad regrets his outburst — just like any parent caught swearing, losing his temper or behaving in a way that he’d dread seeing his kids repeat.

Decades of studies show that we parents (Marc has two kids) are our children’s primary role models. We know our kids pick up on actions more than words. But being a good role model is more than avoiding bad behaviour; it’s also displaying positive habits and actions that we want our kids to emulate.

Diana, Princess of Wales, was celebrated for her activism. She’s seen here in 1977 viewing a selection of landmines at the Mine Training Centre in Viana, Angola in support of the Red Cross campaign to ban anti-personnel landmines. POOL/AFP/Getty Images

When we run workshops with parents, we ask, “What character traits do you want your kids to have?”

Moms and dads rarely answer “successful” or “powerful” — but instead say “compassionate” and “generous.” Yet when we inquire about what they do in their families to explicitly encourage and model those traits, the room often falls silent.

We’re not here to judge. We get it.

It doesn’t take loads of time or money to consciously reflect on how you can proactively ‘be the change you wish to see’ in your children.

Both kids’ and parents’ schedules are jam-packed with lessons, practices and homework, and there’s heavy pressure on parents for their kids to excel in school. But it doesn’t take loads of time or money to consciously reflect on how you can proactively “be the change you wish to see” in your children.

Growing up, we noticed that our dad never swore. Not necessarily from any moral objection, but as a teacher he believed in a wider vocabulary to express frustration and encouraged us to be more articulate with our emotions and opinions.

We also witnessed our mom filling her pockets with “spare change” whenever she went into Toronto so she would have something to give while also striking up a conversation with homeless people she met. Those habits stick with us today.

Instead of merely encouraging our kids to volunteer or be kind to others, perhaps it’s better to show them how much we value giving back.

We recently worked with Hartley Richardson, the CEO of James Richardson & Sons Ltd., and his daughter to build a school in rural Kenya. When we asked what prompted an executive business leader to spend his limited vacation time mixing concrete and raising wooden roof beams, he explained that his usual volunteer work on hospital and charity boards happened out of sight from his kids.

He decided to bring his daughter along to volunteer so they could share the experience together.

You don’t have to volunteer overseas to set an example. Our friend in Vancouver, for instance, makes a point of saying “Good morning” to everyone he passes while cycling his six-year-old to school, and brings his son along when he drops off supper to a single mother in a neighbouring apartment.

It’s hard to start new habits and activities, but investing some thought into the kind of people we want our kids to be pays huge dividends in the long run.

So the next time you catch yourself on the verge of shattering glass at the local arena, you might check out tips on modelling sportsmanship from Active for Life, tips on modeling sportsmanship, a Canadian not-for-profit organization.

In the meanwhile, you can offset your lesser role-modelling transgressions by resolving to set a positive example to your kids and passing on the habits of compassion and generosity that you’d be happy to see them repeat.

Brothers Craig and Marc Kielburger founded a platform for social change that includes the international charity Free The Children, the social enterprise Me to We and the youth empowerment movement We Day.

]]>http://o.canada.com/life/show-kids-a-good-example/feed0Prince Harry In Mozambique Visits Minefields Cleared By The HALO TrustcraigkielburgerDiana, Princess of Wales, was celebrated for her activism. She's seen in 1977 viewing landmines at the Mine Training Centre in Viana, Angola in support of the Red Cross campaign to ban anti-personnel landmines.Prince Harry In Mozambique Visits Minefields Cleared By The HALO TrustAdult diagnosed with measles in Niagara, Ont.http://o.canada.com/health/adult-diagnosed-with-measles-in-niagara-ont
http://o.canada.com/health/adult-diagnosed-with-measles-in-niagara-ont#commentsThu, 05 Feb 2015 16:18:01 +0000https://postmediacanadadotcom.wordpress.com?p=589326&preview_id=589326]]>By Helen Branswell

TORONTO — Health authorities in Niagara, Ont., say a woman in the region has been diagnosed with measles.

A spokesperson for the region’s public health service says the unidentified woman is in hospital recovering from her infection.

Carrie Beatty says the woman was not vaccinated against the highly contagious virus.

Beatty did not know if the woman had recently travelled outside the country.

Canada eliminated spread of the virus in the late 1990s so measles cases that occur here are expected to be linked, directly or indirectly, to international travel.

Earlier this week authorities in Toronto announced they had found four people infected with the virus.

The four — two adults and two children — do not appear to be linked to one another. And none of the four had recently travelled abroad, leading to the assumption that an infected person who has not yet been detected brought the virus into the country.

]]>http://o.canada.com/health/adult-diagnosed-with-measles-in-niagara-ont/feed0Measles Vaccines RundownthecanadianpressCanadian Medical Association says assisted suicide may be humane optionhttp://o.canada.com/news/national/canadian-medical-association-says-assisted-suicide-may-be-humane-option
http://o.canada.com/news/national/canadian-medical-association-says-assisted-suicide-may-be-humane-option#commentsWed, 04 Feb 2015 22:02:21 +0000http://o.canada.com/?p=589019]]>For the first time, the Canadian Medical Association is acknowledging that helping a suffering patient die may be a doctor’s most humane option.

The organization’s updated and recently approved policy on euthanasia and assisted death comes as the powerful doctors’ lobby prepares for a possible lifting of the federal ban on assisted suicide when the Supreme Court of Canada releases its historic ruling Friday morning in Ottawa.

No one is predicting a carte blanche for assisted deaths should the Supreme Court justices deem the current ban too broad.

This time the country may be ready for it

But it has been 22 years since the high court ruled, in a razor edge decision in the Sue Rodriquez case, to uphold the federal laws banning assisted suicide.

“This time the country may be ready for it,” Attaran said.

The Canadian Medical Association — once firmly opposed to any form of doctor-hastened death — has already prepared draft proposals for a “medical aid in dying” regime in Canada. In a new position statement approved by its board in December, the association now states “there are rare occasions where patients have such a degree of suffering, even with access to palliative and end of life care, that they request medical aid in dying. In such a case, and within legal constraints, medical aid in dying may be appropriate.”

If on Friday laws making it a criminal offence to “counsel, aid or abet” another person to commit suicide are lifted, “we’re going to need to hit the ground running if we want to lead and do this well,” said CMA president Dr. Chris Simpson.

Simpson said doctors would be seeking clarification and input on issues such as eligibility: What kinds of conditions would qualify? Would doctor-assisted death be open to fully competent adults only, or their substitute decision makers as well? Would it be restricted to those free of mental illness or clinical depression, and whose terminal, incurable illness is causing enduring and intolerable physical and psychological suffering?

The case before the nation’s highest court involves two British Columbia women, Gloria Taylor and Kay Carter, both who have since died. Lee Carter and her husband, Hollis Johnson, launched the original lawsuit at the B.C. Supreme Court in 2011 on behalf of Lee’s mother, Kathleen (Kay) Carter, who was suffering from a painful and paralyzing spinal condition. Kay Carter died by assisted suicide in a clinic in Zurich, Switzerland, surrounded by her family, after drinking a lethal dose of barbiturates through a straw.

She may be one of the last Canadians to have to travel abroad to realize their wish for an assisted death. Attaran and others expect the Supreme Court will effectively overrule itself when it issues its decision Friday. “This case was always about whether Canadian society has moved on beyond 1993 and the Rodriquez decision,” Attaran said.

The Rodriquez case was “balanced on a knife edge” — a 5-4 split, with now Chief Justice Beverley McLachlin in dissent. McLachlin is also the only justice still on the Supreme Court bench.

During a one-day hearing in October, federal government lawyers — who argued the prohibition against assisted suicide is as vital today as it was in 1993 to protect the vulnerable — faced skeptical questioning from the bench. “There is something stereotypical in your argument that is bothering me — that they, all of them, need protection, a leg up,” McLachlin told one federal lawyer.

From the tenor of the arguments, “I think it’s 90-per cent-plus clear that the Carter camp will win,” said Attaran, who holds the Canada Research Chair in law, population health and global development policy.

Attaran said the court could “take a black marker” and strike out entirely the provision of the Criminal Code that decrees assisted suicide murder. Or it could leave the section intact, but declare it does not apply to individuals in certain situations — for example, people with a terminal diagnosis “who for, whatever reason, are unable to carry out suicide by their own hand,” Attaran said.

“The court could spell out, in greater or lesser detail, what that situation is,” Attaran said.

No one is expecting dying Canadians would rush to doctors to seek a lethal prescription, or lethal injection should the laws be overturned.

But merely knowing the option exists would provide “solace” for patients and their families, “should dying become too difficult,” said Dr. Gerald Ashe, an Ottawa-area family physician and palliative care specialist.

It would also help prevent violent and lonely suicides, he said. In early December, one of Ashe’s patients, a 59-year-old father of three with terminal cancer, shot himself with a rifle.

Opponents of legalized euthanasia are adamant that the court should maintain its ruling in the Rodriquez case. They point to controversial mercy killings — including deaf, twin brothers from Belgium who chose death by lethal injection when they learned they were going blind, and a Belgian woman who was put to death for “untreatable depression” — as evidence that slippery slope fears are real.

“The laws in other jurisdictions have been abused, euthanasia has expanded to include people with depression, people with psychiatric problems, people with dementia, teenagers and incompetent people,” Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said in a statement.

“Canada needs to focus on how it cares for people in difficult circumstances, not how to kill its people.”

Queen’s University bioethicist Udo Schuklenk said that even if abuses may be occurring, “they are occurring in such small numbers that I cannot see how any supreme court in the universe would think these are reasons not to change our take on this issue.”

“The Supreme Court of Canada has always put a lot of weight on social science evidence, and we know support for assisted dying is overwhelming in Canada,” he said.

Support is cutting across political persuasions. “Conservatives are overwhelmingly in favour of it; a majority of Christian Canadians are in favour of it,” Schuklenk said.

“The court will almost certainly take all of this into consideration and will decide that the time has come — regardless of whether politicians think so or not.”

]]>http://o.canada.com/news/national/canadian-medical-association-says-assisted-suicide-may-be-humane-option/feed0assisted suicideskirkeyWorld Cancer Day 2015: A few key facts and figureshttp://o.canada.com/health/world-cancer-day-2015-a-few-key-facts-and-figures
http://o.canada.com/health/world-cancer-day-2015-a-few-key-facts-and-figures#commentsWed, 04 Feb 2015 15:25:03 +0000http://o.canada.com/?p=588665]]>Wednesday, February 4th is World Cancer Day, and health professionals and advocacy organizations around the world are taking the opportunity to draw attention to the ongoing efforts against cancer, as well as tout the latest developments in diagnosis and treatment.

In many ways, we have a lot to be proud of when we look at how much has been achieved in recent decades; however, there’s still a long way to go. Millions of people worldwide will be diagnosed with cancer this year – and among those, many will not survive.

]]>http://o.canada.com/health/world-cancer-day-2015-a-few-key-facts-and-figures/feed0Sue Scott thought she had beaten cervical cancer once, after a combination of external radiation, internal radiation and low-dose chemotherapy made her tumour undetectable by a CT scan.davidkatesU.K. House of Commons approves making babies from DNA of 3 peoplehttp://o.canada.com/health/u-k-house-of-commons-approves-making-babies-from-dna-of-3-people
http://o.canada.com/health/u-k-house-of-commons-approves-making-babies-from-dna-of-3-people#commentsTue, 03 Feb 2015 17:17:12 +0000https://postmediacanadadotcom.wordpress.com?p=588167&preview_id=588167]]>By Maria Cheng

LONDON — British lawmakers in the House of Commons voted Tuesday to allow scientists to create babies from the DNA of three people — a move that could prevent some children from inheriting potentially fatal diseases from their mothers.

The vote in the House of Commons was 382-128 in favour. The bill must next be approved by the House of Lords before becoming law. If so, it would make Britain the first country in the world to allow embryos to be genetically modified.

The controversial techniques — which aim to prevent mothers from passing on inherited diseases — involve altering a human egg or embryo before transferring it into the mother. British law currently forbids any such modification and critics say approving the techniques could lead to the creation of “designer babies.”

The technology is completely different from that used to create genetically modified foods, where scientists typically select individual genes to be transferred from one organism into another.

In the House of Commons, health minister Jane Ellison kicked off the debate by urging support for the change.

“This is a bold step to take, but it is a considered and informed step,” she said, of the proposed technology to help women with mitochondrial diseases.

Critics, however, say the techniques cross a fundamental scientific boundary, since the changes made to the embryos will be passed on to future generations.

“(This is) about protecting children from the severe health risks of these unnecessary techniques and protecting everyone from the eugenic designer-baby future that will follow from this,” said David King, director of the secular watchdog group Human Genetics Alert.

The techniques would likely only be used in about a dozen British women every year who have faulty mitochondria, the energy-producing structures outside a cell’s nucleus. To fix that, scientists remove the nucleus DNA from the egg of a prospective mother and insert it into a donor egg from which the nucleus DNA has been removed. This can be done either before or after fertilization.

The resulting embryo would end up with the nucleus DNA from its parents but the mitochondrial DNA from the donor. Scientists say the DNA from the donor egg amounts to less than 1 per cent of the resulting embryo’s genes.

Last year, the U.S. Food and Drug Administration held a meeting to discuss the techniques and scientists warned it could take decades to determine if they are safe. Experts say the techniques are likely being used elsewhere, such as in China and Japan, but are mostly unregulated.

Rachel Kean, whose aunt suffered from mitochondrial disease and had several miscarriages and stillbirths, said she hoped British politicians would approve the techniques. Kean, an activist for the Muscular Dystrophy Campaign, said her mother is also a carrier of mitochondrial disease and that she herself would like the option one day of having children who won’t be affected.

“Knowing that you could bring a child into this world for a short, painful life of suffering is not something I would want to do,” she said.

A spokesman for Prime Minister David Cameron said he was a “strong supporter” of the change. Cameron had a severely disabled son, Ivan, who died at age 6 in 2009, from a rare form of epilepsy.

Lisa Jardine, who chaired a review into the techniques conducted by Britain’s fertility regulator, said each case will be under close scrutiny and that doctors will track children born using this technique as well as their future offspring. She acknowledged there was still uncertainty about the safety of the novel techniques.

“Every medical procedure ultimately carries a small risk,” she said, pointing out that the first baby created using in-vitro fertilization would never have been born if scientists hadn’t risked experimenting with unproven methods.

Yet Kean said she understood the opposition to the new technology.

“It’s everybody’s prerogative to object, due to their own personal beliefs,” she said. “But to me the most ethical option is stopping these devastating diseases from causing suffering in the future.”

]]>http://o.canada.com/health/u-k-house-of-commons-approves-making-babies-from-dna-of-3-people/feed0Britain-3-Person-Babies.jpgtheassociatedpresscanadaFour unlinked measles cases reported in Torontohttp://o.canada.com/health/four-unlinked-measles-cases-reported-in-toronto
http://o.canada.com/health/four-unlinked-measles-cases-reported-in-toronto#commentsMon, 02 Feb 2015 18:44:25 +0000https://postmediacanadadotcom.wordpress.com?p=587744&preview_id=587744]]>Toronto Public Health has reported four cases of measles in two children and two adults.

And an official of the department admits there are likely more cases in the city because none of the infected people have recently travelled outside the country.

The measles virus does not regularly circulate in Canada, so the only time there are cases here is when an unprotected person gets infected abroad and brings the virus back to Canada.

Sometimes those imported cases don’t lead to local spread, but in other cases they can trigger large outbreaks, such as last year’s epidemic in British Columbia in which more than 400 people became infected.

Dr. Lisa Berger says Toronto Public Health is investigating the four cases to try to determine how the infected people contracted the virus.

She says people need to understand that measles is circulating in Toronto and people born after 1970 who haven’t had two doses of measles vaccine should get vaccinated.

Measles was widespread in Canada before the measles vaccine was introduced in 1970 so people born before that date are believed to be immune because they would have been infected.

Berger says none of the four cases that have been diagnosed had the requisite two doses of measles vaccine.

]]>http://o.canada.com/health/four-unlinked-measles-cases-reported-in-toronto/feed1Demand For Measles Vaccine Increases As Outbreak Started At Disneyland In California SpreadsthecanadianpressNova Scotia student dies from case of meningitishttp://o.canada.com/health/nova-scotia-student-dies-from-case-of-meningitis
http://o.canada.com/health/nova-scotia-student-dies-from-case-of-meningitis#commentsMon, 02 Feb 2015 16:48:15 +0000https://postmediacanadadotcom.wordpress.com?p=587664&preview_id=587664]]>WOLFVILLE, N.S. — A student at a Nova Scotia university has died from bacterial meningitis, Nova Scotia’s chief public health officer said Monday.

Dr. Robert Strang said he was called Saturday when a young woman was brought into the emergency department at the Valley Regional Hospital in Kentville, near Wolfville where she was studying at Acadia University.

He said the woman, whose identity was not being released at her family’s request, was already in critical condition and died the following day in hospital despite being given antibiotics.

“Sometimes infectious diseases can be extremely rapidly progressive and despite the best medical attention we’re not able to be successful in treatment,” he said.

He said they are doing tests to determine what kind of bacterial meningitis affected the young woman, who is not from Nova Scotia. He said that can help determine what kind of vaccine should be given to people who were deemed to be close contacts of the student’s.

Health officials have been talking to people who were in contact with the student and have administered antibiotics in six people. He said none of those contacts has shown signs of illness.

University spokesman Scott Roberts said the school was informed by health officials that a student had become sick on the weekend and died Sunday. He said they’re working with the Health Department to provide people with information on the illness.

“At this point it’s a single isolated case in time on the campus,” he said. “For the general campus community there’s no increased risk.”

Strang said the symptoms of meningitis include fever, headache, a purplish rash and a fast progression of illness.

A Halifax-area high school student died last week after contracting meningitis. Before these two fatalities, Strang said there had not been a death linked to meningitis in the last decade.

]]>http://o.canada.com/health/nova-scotia-student-dies-from-case-of-meningitis/feed0Ruth RutledgethecanadianpressThis week in health: Treating mental illness, ‘unboiling’ eggs, and morehttp://o.canada.com/health/this-week-in-health-treating-mental-illness-unboiling-eggs-and-more
http://o.canada.com/health/this-week-in-health-treating-mental-illness-unboiling-eggs-and-more#commentsFri, 30 Jan 2015 19:38:49 +0000http://o.canada.com/?p=586568]]>Canada.com Health takes a look at a few stories you may have missed this week.

Determining the right course of treatment, whether for mental health or otherwise, always involves a degree of uncertainty. But the more we learn about genetics and about the specific genetic makeup and history of a patient, the more health care professionals are able to devise an effective treatment plan. With genetic testing, physicians are learning so much more about what kinds of medications they can and cannot prescribe their patients.

This is especially true for mental health, since so much of the brain remains unknown. “The brain represents a mysterious and unexplored territory,” says Dr. James Kennedy, head of neuroscience research at the Centre for Addiction and Mental Health. “With computer technology and our genetics and good clinical care, we can figure out the blueprint of their brain and start to make new discoveries that might lead to new medications that don’t have these nasty side effects.”

Scientists may have just learned how to do something previously thought impossible: “unboiling an egg”. And in case you think it’s really just some kind of useless stunt, apparently it isn’t: in fact, it may prove extremely useful for cancer research. In particular, the hope is that the unboiling process will allow scientists to effectively produce cancer-associated proteins – key components in cancer cell division and the growth of tumours.

It actually solves a vexing problem that they’ve had for years, in that they’ve been unable to produce those proteins. Typically when they’re extracted from bacteria cells in a lab, says Gregory Weiss of the University of California, Irvine, “they form sticky, tangled protein masses that look like boiled egg whites.” Thankfully, the boiling process, as it turns out, doesn’t affect protein connectivity and bonding. They remain chemically unchanged, so “unboiling” them effectively untangles the proteins and leaves them intact.

The above video from Futurama is a great introduction to this sweet little news item. Just when you thought you were eating foods that were free of animal products, an article from Eat This, Not That! suggests you think again. It’s not just the gelatin in your candy or that stray beetle on your celery; in fact, a lot of foods that you’d think would have nothing to do with animal products, as it turns out, contain them by virtue of some strange, rarely-revealed food processing methods. And most of these things hide safely under the “natural flavour” section of the ingredients lists, so, hey, you’d never know!

A few examples? Try charred cattle bones in your white sugar, since the bleaching process means running the sugar through so-called “bone char” or “natural carbon”. Or bacteria-fighting shellfish extracts sprayed onto our bananas. And the next time you enjoy a bagel, you may also be consuming a compound known as L. Cysteine, which is derived from duck or chicken feathers. But our favourite, however, has to be something called castoreum, which is a common ingredient in vanilla ice cream. What’s that, you may ask? Well…according to the article, it’s “a fragrant, brown slime that beavers use to mark their territory.” Oh, but it’s so delicious.

]]>http://o.canada.com/health/this-week-in-health-treating-mental-illness-unboiling-eggs-and-more/feed0resizeMental Health ImagedavidkatesBeating the ‘blues and blahs’ of Seasonal Affective Disorderhttp://o.canada.com/health/beating-the-blues-and-blahs-of-seasonal-affective-disorder
http://o.canada.com/health/beating-the-blues-and-blahs-of-seasonal-affective-disorder#commentsFri, 30 Jan 2015 14:48:15 +0000http://o.canada.com/?p=585268]]>With Canadians now enduring the shortest, coldest days of the year, many of us will experience symptoms of malaise: lethargy, feelings of withdrawal and apathy, and an overwhelming desire to stay in bed and indulge in comfort foods.

To some, it might just be a case of the winter blues, a transient period of mild depressive symptoms that usually hits people around this time of year. But to others, the condition is more serious, crossing a clinical threshold to become what we know of as seasonal affective disorder, or SAD.

Unfortunately, many people needlessly suffer through it in silence. It’s important to recognize the symptoms of SAD, take action – and seek help.

Seasonal affective disorder: More than just feeling blue

According to Trix VanEgmond, a mental health educator for the Middlesex branch of the Canadian Mental Health Association, as many as half of all Canadians will experience depressive symptoms through the winter months. But among that rather large number, the severity of those symptoms varies substantially.

About 25-35 per cent, for example, suffer from the milder form commonly known as the ‘winter blues.’ “If you have symptoms for a couple of days, then that would be more likely the winter blues,” says VanEgmond. If it persists for several weeks, she says, it’s more likely what she refers to as “seasonal depression,” – a mild depression that affects roughly 10-15 per cent of Canadians.

A further two to five per cent are diagnosed with seasonal affective disorder, with symptoms that can carry on for months at a time and are often considerably more severe. It’s more than just feeling a little blue.

How is it identified? “One of the things to know about a diagnosis of SAD is that it’s like regular depression, except that it has a seasonal pattern specifier,” says VanEgmond.

“It could be [experienced in] summer. And you have to have remissions. You have to feel better after that season is done – it’s not that you have year after year of unremitting depression. You have a seasonal depression and then you have a recovery.”

For a diagnosis of SAD, she adds, the symptoms must be experienced for two successive years, during the same season (whether winter or otherwise). It must also be determined to be brought about by the season itself rather than other concurrent factors.

How bad can it get?

Two defining symptoms experienced by SAD patients are increased sleep and appetite – the opposite of what’s typically seen among sufferers of regular depression.

SAD sufferers, of course, experience many of the typical symptoms of depression. “We need to see the ‘blues’ or the ‘blahs,’” says VanEgmond. “ When I say ‘blues,’ I mean sad. And when I say ‘blahs,’ I mean apathetic or generally having a sort of ‘I don’t care about anything’ attitude.”

Other symptoms to watch out for include: feelings of withdrawal or isolation; anger and irritability; increases in body aches; and difficulty with memory and concentration. Low self-esteem is common, as is a lack of interest in activities the patient normally would enjoy. Poor personal hygiene, as well as a weakened immune system, means that many SAD sufferers also tend to get sick more often. Suicidal thoughts may occur as well in the most extreme cases.

Underlying causes

“The causes of it are still not really very [clear],” says VanEgmond. “We do know that serotonin plays a part in it, but we don’t know if we can really change that or how that’s related to the sun. There’s some theories about delayed biological rhythms, something about circadian rhythms, that we’ll notice our body clock that way.”

What is known, however, is that SAD is connected to a prolonged lack of exposure to sunlight – which, as alluded to earlier, can occur in summer as well as winter. But it’s more common in winter simply because there are fewer hours of sunlight, and weather that discourages people from spending time outdoors.

Treating Seasonal Affective Disorder

The primary treatment, then, is first and foremost about getting more sunlight – known here as “light therapy” – whether naturally or through artificial sources. VanEgmond urges people do whatever they can to get more exposure to natural light. “I drive with the sunroof open,” she says. “In a car that doesn’t have a sunroof, I drive with the windows open and the heat on.” Even if it’s just for 10-15 minutes a day, she notes, it’s typically all the body needs.

Exercise, too, can help not just against SAD, but against general anxiety and depression. “It gets rid of a lot of that angst, as well as make a positive impact on the mood,” she says.

In more severe cases, VanEgmond says, light therapy efforts are often supplemented with a course of antidepressants.

What works – and what doesn’t

If getting outside more isn’t enough, light therapy can come in the form of a speciallydesignedlamp intended to mimic the type and intensity of light we would experience outside. They are, however, costly to purchase and not always covered by private insurance plans.

VanEgmond warns against other products that purport to do the same job for less money – for instance, a $100 “blue light therapy” lamp that retails at Costco – as they are rarely as effective, since they produce only a fraction of the amount of light necessary to replicate outdoor conditions. Measured in units called “lux”, daylight is anywhere between 15-30,000 lux. While a proper SAD lamp will produce 10-15,000 lux, many cheaper products will produce far less – just 200 lux in the case of the Costco product. Lighttherapyglasses and visors are also available and may help (depending on how much and what kind of light they produce), but the notion of wearing and walking around with a light therapy device may not be practical.

Beware, as well, of tanning salon providers who advertise their services as a treatment for SAD. Light therapy, she says, requires a specific kind of light – and it’s not tanning lights. “Tanning studios will certainly tell you, ‘We will help with seasonal depression,'” says VanEgmond. “It’s baloney. They do not help.”

The same thing, she says, goes for vitamin D and other nutritional supplements. While unlikely to be harmful, they’re not considered to be an effective treatment for seasonal affective disorder.

Regardless of the course of treatment, the bottom line is it’s important to seek help if you’re experiencing symptoms – and consult your physician to determine the best course of treatment.

Finding the right SAD therapy lamp

Is it made specifically to treat SAD? Some lamps or light boxes are designed to treat skin disorders and are not effective against SAD. Some emit more UV rays than SAD lamps and can be damaging to the eyes.

How bright is it? SAD lamps should be between 10-15,000 lux. Products that emit a lesser amount are not recommended as they are less likely to be effective.

White or blue light? A SAD therapy lamp should use bright white light. Many products tout their use of blue light, but there’s not much evidence to support their effectiveness in treating SAD.

Can you put it in the right location? Your lamp or light box should be placed 2 feet in front of you.

Does your doctor recommend it? You should discuss your professional light box options with your doctor.

Take Our Poll]]>http://o.canada.com/health/beating-the-blues-and-blahs-of-seasonal-affective-disorder/feed2depressed_man1024davidkatesCanadian clinic first to offer controversial new form of IVFhttp://o.canada.com/health/fertility-treatment-that-seeks-to-extend-womens-child-bearing-years-raises-debate
http://o.canada.com/health/fertility-treatment-that-seeks-to-extend-womens-child-bearing-years-raises-debate#commentsThu, 29 Jan 2015 21:50:50 +0000http://o.canada.com/?p=585916]]>A Canadian fertility clinic has become the first in North America to offer women a way to add new life to old eggs, extending her child-bearing years and stirring fresh controversy in the largely unregulated world of assisted baby making.

The technique involves rejuvenating a woman’s mature eggs using healthy, young, energy-producing cells harvested from tiny pieces of tissue taken from the outer edges of her own ovaries.

The pricey procedure, called AUGMENT, is aimed at women with “compromised” egg health who long to carry their own biological babies and who don’t want to use eggs from younger donors.

TCART’s medical director, Dr. Robert Casper, says the treatment could help couples that have struggled through failed cycles of in-vitro fertilization (IVF) because of poor egg quality.

Younger women can have poor quality eggs because of inherited reproductive disorders, environmental factors or other medical conditions.

A scientist works on a nonviable embryo in this file photo. (Richard Drew/ Associated Press) []

But the new procedure, developed by Massachusetts-based OvaScience, is also being marketed to the wave of women postponing child-bearing only to discover their own eggs have effectively expired.

“The median age in our clinic last year was 39, which makes half the women we saw for the first time last year over 40,” said Casper, a professor of obstetrics and gynecology at the University of Toronto.

“The problem with waiting a bit is that the eggs have been there since you were born,” he said. “It’s like a flashlight that’s been sitting on a shelf in a closet for 35 years — the flashlight itself is OK, but the battery has rundown.

“And that’s what AUGMENT is doing: replacing the batteries.”

The clinic has achieved several pregnancies so far, including one 30-year-old woman now 10 weeks pregnant with twins.

Experts in ovarian physiology are watching closely.

“I think all of us that live in the ovary science world are really anxious to see what they’ve done,” said Dr. Roger Pierson, a professor of obstetrics and gynecology at the University of Saskatchewan.

You’re innovating in an area where the burden of a bad outcome goes on for a lifetime and the person bearing the highest cost can’t consent

Others say that, with scant published data to go on, too little is known about the potential risks — including to the babies.

“You’re innovating in an area where the burden of a bad outcome goes on for a lifetime and the person bearing the highest cost can’t consent,” noted American bioethicist Arthur Caplan told the Canadian Medical Association Journal in a recently published article about AUGMENT.

By the time a woman reaches her late 30s, the quality of her eggs begins an irreversible slide.

Eggs have 46 chromosomes to begin with, but they undergo a change when a woman ovulates. Each egg discards 23 of its chromosomes and, if it’s fertilized, takes in 23 from the sperm cell to replace them. That process requires a lot of energy.

In vitro fertilization funding has become an increasingly public discussion over the past few years. Now, a new form seeks to improve an older woman’s eggs instead of relying on luck or a donor. [REUTERS/Kacper Pempel]

The energy in eggs, and essentially in all human cells, is produced by mitochondria, little power packs that weaken with age. If there isn’t enough energy to separate the chromosomes properly, some get left behind, resulting in chromosomal abnormalities such as Down syndrome.

The idea behind AUGMENT is to boost the energy in older eggs by adding younger mitochondria harvested from egg-making stem cells, or precursor cells, that scientists only recently discovered exist in the lining of adult ovaries.

One of those scientists, Jonathan Tilly, is a co-founder of OvaScience.

It’s not yet clear what effect adding younger mitochondria to older eggs could have on babies

Pierson, of the University of Saskatchewan, said it’s not yet clear what effect, if any, adding younger mitochondria to older eggs could have on AUGMENT-conceived babies.

However, he believes it’s safer than controversial experiments conducted in the early 2000s, when U.S. researchers transferred mitochondria from a younger woman’s eggs into the eggs of older women, effectively creating babies born with genetic material from three people, including a second “mother.”

The experiments were roundly criticized as a threat to human heredity. But they resulted in the births of 58 babies “who appear to be fine,” OvaScience spokeswoman Theresa McNeely said in an email to Postmedia News.

McNeely said published studies involving mitochondrial transfer in animals and humans also show the procedure is safe and can increase the likelihood of fertilization and healthy, live births.
With IVF alone, success rates for older women are dismal: In Canada, the live birth rate per cycle of IVF started is about 10 per cent for women 40 and older. McNeely said OvaScience doesn’t have live birth rates for AUGMENT yet, but that the information is being collected for an international patient registry.

AUGMENT also uses a woman’s own mitochondria — not mitochondria from another woman, and because the material comes from the woman’s own body and isn’t manipulated, the procedure falls under Health Canada guidelines for “cell therapy,” Casper said, meaning the company doesn’t have to apply for a new drug submission.

The U.S. Food and Drug Administration believes otherwise: In 2013, OvaScience voluntarily halted enrolling women in U.S. trials after the FDA demanded it file an “investigational new drug” application. TCART in Toronto is one of only four reproductive centres in the world currently offering AUGMENT. The others are in the United Kingdom, the United Arab Emirates and Turkey.

“I would assume that if the embryos survive and you get a fetus implanted and growing that it shouldn’t be any different from a natural pregnancy,” he said. “I don’t think it’s very risky at all.”
Today, embryos created via IVF are often grown to the so-called “blastocyst” stage — five-days after fertilization — before being transferred to the woman’s uterus. But if a woman has poor-quality eggs, the embryos will often “arrest” before the fifth day, Casper said. “They don’t make it.”

With AUGMENT, three small pieces of ovarian tissue are taken during a laparoscopic biopsy. The tissue is frozen within an hour of collection, then thawed and specially processed to isolate the mitochondria.

A month after the biopsy, the woman undergoes a full IVF stimulation. The woman is given drugs to stimulate her ovaries to churn out multiple eggs. The eggs are retrieved from her ovaries, and then the mitochondrial preparation is injected along with her partner’s sperm into the eggs.

“The idea is to put back a few thousand mitochondria that hopefully will divide and repopulate the egg with healthy young mitochondria,” Casper said.

“We’ve had a few pregnancies already in the first 14 completed embryo transfers,” he added. All the pregnancies have been in women under 40 so far. Among the next 30 patients, “there will be a number of women (aged) 42, 43, and maybe even 45,” Casper said.

“I think it would be fantastic if it works for older women, because we really don’t have much to offer them,” he said.

A Toronto woman says she tried AUGMENT as her sixth try at IVF and is now pregnant, healthy and happy. (File photo) []

AUGMENT will cost about $25,000, on top of the cost of IVF, which usually runs about $12,000.

For one 30-year-old Toronto woman, AUGMENT was her sixth attempt at IVF.

“I have poor egg quality and I was a poor responder to medication — I would only get one or two eggs at the end and they wouldn’t fertilize,” said the woman, who asked not to be identified for reasons of privacy. She estimates she and her husband have spent $55,000 to $60,000 on failed fertility treatments over the past five years.

“It’s really intense, it’s really isolating and it takes a toll on your marriage and your friendships,” she said. “We were at the point where we had given up, and then this new treatment came about. It was a new chance for us.”

She became pregnant in early December, after one cycle of IVF with AUGMENT.

“I feel great. The pregnancy is going well,” she said. “I just feel very fortunate to have been part of this.”

]]>http://o.canada.com/health/fertility-treatment-that-seeks-to-extend-womens-child-bearing-years-raises-debate/feed0Robert CasperskirkeyA scientist works on a nonviable embryo in this file photo. (Richard Drew/ Associated Press)In vitro fertilization funding has become an increasingly public discussion over the past few years. Now, a new form seeks to improve an older woman's eggs instead of relying on luck or a donor. A Toronto woman says she tried AUGMENT as her sixth try at IVF and is now pregnant, healthy and happy. (File photo)B.C. woman tests positive for H7N9 bird fluhttp://o.canada.com/news/national/b-c-woman-tests-positive-for-h7n9-bird-flu
http://o.canada.com/news/national/b-c-woman-tests-positive-for-h7n9-bird-flu#commentsMon, 26 Jan 2015 22:09:21 +0000http://o.canada.com/?p=584161]]>The first North American human case of H7N9 bird flu has been confirmed in B.C.

Canadian health officials announced Monday that a woman in her 50’s from B.C.’s lower mainland has tested positive for avian influenza A(H7N9), the potentially deadly virus that has infected hundreds of people in China since first emerging in humans in March 2013.

Another family member, a man, who travelled with the B.C. woman to China is believed to have been infected as well. They only developed symptoms after returning home to Canada earlier this month.

Both are recovering well and did not require hospitalization, federal health minister Rona Ambrose said during a hastily called press conference from Ottawa Monday.

Ambrose said the risk to Canadians is low, and that there is no evidence the virus transmits easily from person-to-person.

According to the World Health Organization (WHO), most known human infections with H7N9 resulted from exposure to infected live poultry, or contaminated environments, such as markets where poultry is sold and slaughtered.

Canada’s public health agency has notified China, WHO and other international agencies about the Canadian case, Ambrose said.

All potential contacts are being followed up, B.C. Health Minister Terry Lake said. “We are working closely with the Public Health Agency of Canada to ensure a robust and coordinated response,” Lake said.

Common symptoms included fever, cough and shortness of breath. In China, most of the infected developed severe pneumonia. There have been at least 175 confirmed deaths in China.

H7N9 influenza isn’t the same as seasonal flu that circulates every winter, stressed Dr. Gregory Taylor, Canada’s chief public health officer. H7N9 is an avian form of influenza that circulates among birds. However, this particular strain has never been found in wild or domestic birds in Canada, Taylor said.

It’s also not like H5N1 bird flu — the virus that last year infected and killed a young Alberta woman who had travelled to Beijing. H5N1 transmits more easily between birds, and between people, Taylor said.

The B.C woman with confirmed H7N9 became sick after returning to Canada on Jan. 12. Taylor said she had travelled to “various locations” in Canada. She began to feel sick on Jan. 14 and sought medical help but wasn’t sick enough to require hospitalization, Taylor said.

Officials said they’re confident the B.C. residents, who became sick within a day of each other, got sick from the same common exposure, rather than from transmitting the virus from one to the other.

Neither the man nor woman had symptoms while they were travelling. Officials said there is likely no risk to other travellers.

Both are in “self-isolation” at home. All close contacts have been identified and their health is being monitored. None of the identified contacts has developed flu-like illness. Given that, “it is extremely unlikely that we will see any additional cases here in B.C.,” said B.C. deputy provincial health officer Dr. Bonnie Henry.

Henry said it’s not surprising that a single case of human H7N9 infection has been imported to Canada, given the virus been circulating in China since 2013.

B.C. health officials notified the federal public health agency on Jan. 23 of that it was dealing with a potential case. A sample was sent to Canada’s national microbiology laboratory in Winnipeg on Sunday for testing. The lab confirmed the diagnosis Monday morning.

“All evidence is indicating that it is likely the individual was infected following exposure in China,” Taylor told reporters.

The woman and her male companion were visiting China as tourists. They didn’t visit poultry farms. “They did some touring of areas and villages in China where poultry are seen throughout the village but there was not a particularly high-risk exposure that we were able to identify,” Henry said.

Taylor said Canadians travelling to China should avoid high-risk areas, such as poultry farms and live animal markets, and ensure all poultry dishes, including eggs, are well cooked.

Anyone who has travelled to an infected area and becomes ill should seek medical attention, Henry said. “But call in advance, and let them know of your travel or exposure information so proper precautions can be taken.”

skirkey(at)postmedia.com

Twitter.com/sharon_kirkey

]]>http://o.canada.com/news/national/b-c-woman-tests-positive-for-h7n9-bird-flu/feed0HONG KONG-CHINA-HEALTH-FLU-VIRUSskirkeyToronto cardiac team successfully replaces aortic valve through neck incisionhttp://o.canada.com/news/toronto-cardiac-team-successfully-replaces-aortic-valve-through-neck-incision
http://o.canada.com/news/toronto-cardiac-team-successfully-replaces-aortic-valve-through-neck-incision#commentsSun, 25 Jan 2015 19:50:05 +0000http://o.canada.com/?p=583631]]>Toronto surgeons have rewritten the old adage that the fastest way to a man’s heart is through his stomach.

In fact, it’s through his neck.

A team from Toronto’s St. Michael’s Hospital has become the first in North America to replace a narrowed aortic valve through an incision in the neck, rather than the chest or groin.

Heart surgery traditionally involves cutting through muscle in the chest, sawing through the sternum and spreading the breastbone apart to expose the heart.

Surgeons can also take a more “minimally invasive” route by making small holes in the chest — which still involves cutting through muscle between the ribs — or reaching the heart via the femoral artery, the large artery in the groin.

The new procedure goes even further. A small, central horizontal incision is made just above the sternal notch, or about one finger width above the sternum. Next, a collapsible valve is placed on a balloon-tipped catheter and fed into the artery.

A special device allows surgeons to land on, and deliver the catheter in from the aortic arch — a far more direct route to the ultimate target than going up through the groin.

Toronto surgeons led the first team in North America to use a new device allowing them to replace an aortic valve from an incision in the neck rather than the chest or groin. PHOTO: St. Michael’s Hospital

“You’re just really cutting a little bit of skin and fat and you’re going into a plane just in front of the windpipe, or the trachea, ” said cardiac surgeon Dr. Mark Peterson, of St. Michael’s Hospital.

“Even though it sounds kind of morbid, it’s really quite a small incision, and there really aren’t a lot of nerve cells in fat. So when the patients wake up, they just don’t have any pain.”

For patient Don Pruner, the only scar is a three-centimetre line on his neck.

“I had no pain. The only thing I had was a little bit of discomfort in the throat, where they put the breathing tube down, and that was it,” said Pruner, 82.

Aortic stenosis, or narrowing of the aortic valve in the heart, is one of the most common problems of aging, affecting about five per cent of the elderly. Hard, calcium deposits on the valve make the valve stiff and harder to open properly, forcing the heart to work harder to pump blood through the valve. Severe stenosis increases the risk of sudden cardiac death.

The new procedure is designed for patients such as Pruner, whose age and 30-year history of diabetes made him too risky for traditional, open-heart surgery. The arteries in his groin also were not large enough to allow surgeons to get the valve in from the groin.

Before surgery, Pruner suffered from shortness of breath and dizziness. He could hardly make it up a flight of stairs.

“I had to be exceptionally careful how I got up,” he said. “I would go out of my mind if all I could do was sit in a chair and watch TV. It wasn’t living; all you’re doing is existing.”

“I have more energy now. I feel better. From what all my friends tell me, I look much better too. I have more colour in my face.”

Peterson and Dr. Chris Buller, an interventional cardiologist, led the St. Michael’s team. Pruner’s surgery took place in October; another procedure was performed the same afternoon.

The novel system, developed by U.S. interventional cardiologist Dr. Richard Stack, uses a specially shaped illuminated retraction system and a balloon-expandable valve. Like other artificial valves, the leaflets are made of cow tissue, or bovine pericardium — the sac around the cow’s heart. However, this valve is mounted on a stainless steel strut that allows the valve to be collapsed. It’s loaded onto the balloon catheter, snaked up through the artery and, once the target is reached, the balloon is inflated, and the valve pushed into position.

“There’s no cutting the old valve out, there’s no sewing the new valve in,” Peterson said. The valve stays fixed in place and doesn’t recoil once it’s deployed.

“You don’t need a big incision. You don’t need to go on the heart-lung bypass machine, and the recovery is faster,” Peterson said.

The first four cases in the world were performed in Colombia, South America. “The two cases we did were the fifth and sixth in the world,” Peterson said.

For now the new technique is being developed for those too sick or too old for traditional valve surgery. It is available for compassionate use only, and is not approved by Health Canada, so it isn’t yet widely available.

“What we do now is very good, in terms of conventional surgery, and has improved dramatically over the last 30 years,” Peterson said.

“Minimally invasive operations have a downside, and for many patients, the conventional operation is not only preferred, but possibly safer and has a much longer track record in terms of long term durability and outcome,” he said. Working through a smaller incision and tighter working space can also be technically trickier than a large, open field.

The decades-long War on Drugs continues to shape our conversation around addiction, meaning that many of us have held on to a handful of preconceived notions and inaccurate beliefs well beyond their expiration dates. It’s something that author and journalist Johann Hari is hoping to address with his new book, “Chasing The Scream: The First and Last Days of the War on Drugs.”

A detailed discussion of his book can be found in an interview included above, but chief among Hari’s concerns is that we continue to misunderstand the real causes of addiction – and what we think we understand is clouded by our ideological beliefs. Is addiction a moral failure? Or is it a disease that results from a chemical dependency? He argues it may actually have more to do with the environment we live in and the social support networks we have (or don’t). It’s a fascinating re-evaluation of something many of us thought we already knew.

You may have heard the argument from the anti-vaccination crowd that there’s no need for a measlesvaccine, because the disease really isn’t that serious. No big deal if your kid doesn’t get vaccinated, goes to Disneyland and happens to contract the disease and spread it to others. And – as if we couldn’t re-state it enough times – no big deal if the main reason you’re refusing the measles vaccine is because of misinformation about a link to autism, stemming from a long-discredited study that The Lancet retracted years ago.

Well, here’s a shocking piece of information, according to Slate: it is serious. It’s a dreadful disease. It’s highly contagious, and public health officials need to quarantine anyone who contracts it. And while only a small percentage of measles patients die, it leads to a host of complications, including pneumonia and encephalitis. This sort of thing might have simply meant a course of antibiotics a few decades ago, but we’re living in an age of superbugs and growing antibiotic resistance. It’s yet another chance not worth taking – especially when the risks associated with the vaccine itself have repeatedly been reported as low.

This handout photo provide by the University of Pittsburgh Medical Center, taken March 5, 2014, shows Dr. Christian Bermudez of the University of Pittsburgh Medical Center checking patient Jon Sacker, who was being treated with an experimental device called the Hemolung that acts like dialysis for lungs. [AP Photo/University of Pittsburgh Medical Center]

We’re currently running an excellent three-partseries on end-of-life care. But elsewhere, different media outlets are having similar discussions. When you’ve been diagnosed with a life-threatening illness, it’s important for your physician to ask you questions about your course of treatment, what your concerns are, and determine your wishes should the treatment turn out to be ineffective or to entail risks that you may not be willing to take.

Speaking for HealthLeaders Media, Jacqueline Fellows offers up six questions every doctor for ask their patients, particularly those who may be facing the prospect of palliative care. Among them: What kinds of things are important to you in your life? If you were not able to do the activities you enjoy, are there any medical treatments that would be too much? What fears do you have about getting sick or medical care?

]]>http://o.canada.com/health/this-week-in-health-addictions-examined-measles-facts-and-more/feed0heroin_syringe_spoon_powderdavidkatesFile photo of a measles patient.This handout photo provide by the University of Pittsburgh Medical Center, taken March 5, 2014, shows Dr. Christian Bermudez of the University of Pittsburgh Medical Center checking patient Jon Sacker, who was being treated with an experimental device called the Hemolung that acts like dialysis for lungs. Doctors credit the experiment with buying Sacker time to improve enough to undergo a lifesaving double lung transplant later that month. (AP Photo/University of Pittsburgh Medical Center)End of life care: Creating an exit strategyhttp://o.canada.com/health/end-of-life-care-creating-an-exit-strategy
http://o.canada.com/health/end-of-life-care-creating-an-exit-strategy#commentsFri, 23 Jan 2015 16:30:20 +0000http://o.canada.com/?p=582426]]>On a warm summer day in 2011, Alain Berard learned he would die from a disease that will eventually take away his ability to move, swallow or breathe on his own, before it kills him.

It took 11 months for doctors to understand what was going wrong inside his body. Once an avid runner, Alain began experiencing cramping and fatigue in his legs. He thought he was over-training.

Then he started having trouble swallowing.

His heart, blood and thyroid gland were checked before a specialist saw the tremors and quivering at the back of his tongue.

A lumber puncture and brain scans were ordered, to rule out multiple sclerosis and other neurological disorders, and as each test came back negative,Berard’s panic grew. He remembered the pictures on TV only months earlier of former Montreal Alouettes star Tony Proudfoot, who died of amyotrophic lateral sclerosis, or ALS — Lou Gehrig’s disease, an illness that normally ends in death within two to five years.

Alain Berard, who was diagnosed with ALS takes a phone call in his office in Blainville. [Christinne Muschi for Postmedia News]

“I would have taken any other diagnosis before ALS,” Berard, now 48, says.

ALS is one of the most devastating diseases known to man, an incurable illness that attacks the nerve cells in the brain. But ALS is also a disease apart, because it allows patients to create what neurologist Dr. Angela Genge calls an “exit strategy” — and we can all learn from them how to better prepare for our own deaths.

“These patients go from that mindset to, ‘I’m dying, and I’m going to die a death in which I become disabled.’ This disease becomes extremely scary.”

But then two things change: most people recover from the diagnosis, psychologically, Genge says. “They know what is going to happen to them, and then each signpost along the way is another step, another conversation,” she said. What is it you need to do before you die? How much do you want us to do to keep you alive?

“It is very common that they want a promise from their doctor, that when they don’t want to live, they can stop living. They can die. They want control over what will happen.”

Dr. Angela Genge, director of the ALS clinic at the Montreal Neurological Institute and Hospital, says ALS allows people to prepare for their own deaths – a process we can all learn from. [Graham Hughes/Postmedia]

Alain Berard is now three-and-a-half years into his dreaded diagnosis. He looks incongruous, sitting in his wheelchair. The pieces don’t fit: He is six feet, three inches tall, with broad shoulders and chest. Yet he is speaking frankly about whether he would ever accept a feeding tube in his stomach, or a tracheotomy — a surgical incision in his windpipe so that a ventilator could pump air into his lungs.

His wife, Dominique, a schoolteacher, has been taught the Heimlich maneuver and what to do if Alain suddenly starts choking. She is petite, but strong. She is preparing for the day she will have to take over complete care of her husband, “because I will be like a child, like a baby,” Alain says.

His disease is moving slowly. He’s taking antidepressants to help with his mood. He sometimes feels himself retreating emotionally, going inward. “I sometimes have thoughts I keep to myself, to protect my family.” He volunteers for the ALS Society of Quebec, work he finds “so nourishing.”

He doesn’t know yet how much he would be prepared to endure, or, if his condition worsens after Quebec’s “medical aid in dying” law takes effect, whether he would consider asking his doctor to help end his life

“Some people with ALS, it goes very fast. Some decide to prolong life. Others will decide, ‘enough is enough. It’s a dead situation anyway,'” he says.

Alain Berard, who was diagnosed with ALS helps direct dinner preparation with his family at home in Blainville, Quebec. (From L- Noemie, Charlotte, Alain and Dominique [Christinne Muschi for Postmedia News]

“It’s always a debate. What would I want for myself, and for my family?”

As the Supreme Court of Canada weighs lifting the federal prohibition on assisted suicide, in Quebec, the hypothetical will soon become real.

The Quebec law is expected to go into effect at the end of this year. A special commission established to set the ground rules for assisted death will begin work next month.

No one is expecting a torrent of requests for euthanasia or assisted suicide when the Quebec law comes into force, or if the Supreme Court rules, as many expect it will, that the current federal prohibition is too restrictive and a violation of our personal autonomy.

In October, lawyers arguing on behalf of two B.C. families pushing for a change in the federal law, said the blanket prohibition on euthanasia is creating back alleys for assisted suicide, where people die with turkey bags filled with helium, or take drugs bought over the Internet from Thailand or Mexico that may leave them brain damaged or even worse.

Others believe assisted suicide is already occurring in far less desperate ways — with the help of doctors.

In 1994, witnesses testifying at a special Senate committee on euthanasia said physician-hastened deaths are happening clandestinely, and that the law, as it now stands, is not being enforced.

“I have spoken with physicians who have been involved directly in the process. I know for a fact that it does occur on a regular basis,” Dr. Michael Wyman, a past president of the Ontario Medical Association said. “Those who say that it does not are either not talking with many physicians or deliberately turning a blind eye to the numbers.”

Some countries have national standards for continuous palliative sedation. Canada does not. The Canadian Society for Palliative Care Physicians has proposed a national policy, reserving continuous palliative sedation for untreatable and intolerable suffering, and only when death is expected within one to two weeks.

Alain Berard, who was diagnosed with ALS looks at the adaptation, a motorized lift that will be able to carry him from the bathroom to his bed, installed at home in Blainville, Quebec. [Christinne Muschi for Postmedia News]

“When people say there is no difference between sedating somebody and euthanizing them, I think they haven’t worked enough with dying patients — because people who do, know there is a difference,” says Dr. Manuel Borod, director of the supportive and palliative care programs at the McGill University Health Centre in Montreal.

Dr. Jeff Blackmer, the Canadian Medical Association’s director of ethics, said there are anecdotal reports doctor-assisted deaths are occurring in Canada.

“But I think it’s important to note that I have never had a doctor tell me, either in person or online or otherwise, that they have participated in this type of activity. Never once,” Blackmer said.

With palliative sedation, people sleep until they die, a process that can take up to a week.
Euthanasia involves an injection of barbiturates that abruptly kills.

While few doctors have come out publicly in support of legalizing assisted suicide, many spoke poignantly last summer at the Canadian Medical Association’s annual general council meeting in Ottawa.

“The disease itself put you in a certain state. But the only way you die from ALS itself is by respiratory failure, and if you remove that piece by going on a ventilator, then you literally continue until other organs, like the heart, fail.”

Some said dying farm animals are treated more humanely than patients, and that there are times when the most compassionate thing to do is to stop a heart beating.

People with ALS fear two things: dying by choking, or dying by suffocation. Genge tells her patients: These are not untreatable problems you have to suffer through. “We can manage every one of those symptoms so there is no suffering,” she said.

“The disease itself put you in a certain state. But the only way you die from ALS itself is by respiratory failure, and if you remove that piece by going on a ventilator, then you literally continue until other organs, like the heart, fail,” Genge said. One patient who died last year had been on a ventilator, at home, for 17 years.

Without ventilation, the prognosis is two to five years.

Alain Berard understands his disease is following an arc. “I’m pretty close to the edge, where it’s going to fall off. But I do my best not to overexert myself.”

Alain Berard, who was diagnosed with ALS relaxes with wife Dominique Racine at home in Blainville, Quebec. [Christinne Muschi for Postmedia News]

He and Dominique have installed a lift on the ceiling above his bed in a room specially renovated for Alain. He has chosen where he will be cremated and buried. “I can go and see where I’m going to be.” He is preparing a Power Point presentation for his funeral — photos of himself with his girls, Noemie, 20, and Charlotte, 17, and videos of his impersonations of Quebec politicians.

When he dies, his brain and spinal cord will be donated to the Douglas-Bell Canada Brain Bank, the tissues distributed to researchers searching for ways to fight this unforgiving disease.

“I’m in a wheelchair. This I can cope with,” says Alain. “But there will be a time that it will be too difficult for me and my family to see me in this condition.”

He tells his daughters how lucky he feels to still be alive and able to talk. He encourages them “to take the precious time that we have together.”

He supports Quebec’s law that could give people like him a more gentle death, should they choose it.

“I consider it as an option, like a feeding tube, or a tracheostomy. It’s like a treatment for the end of life, when the illness is too difficult to cope with,” he says.

“When you say, you know what? I’ve had enough. I don’t want to do this anymore.”

]]>http://o.canada.com/health/end-of-life-care-creating-an-exit-strategy/feed3End of Life PT3skirkeyAlain Berard, who was diagnosed with ALS takes a phone call in his office in Blainville. Dr. Angela Genge, director of the ALS clinic, poses for a photograph at the clinic in Montreal.Alain Berard, who was diagnosed with ALS helps direct dinner preparation with his family at home in Blainville, Quebec. (From L- Noemie, Charlotte, Alain and DominiqueAlain Berard, who was diagnosed with ALS looks at the adaptation, a motorized lift that will be able to carry him from the bathroom to his bed, installed at home in Blainville, Quebec. Alain Berard, who was diagnosed with ALS relaxes with wife Dominique Racine at home in Blainville, Quebec.End of life care: A shift to living well before dyinghttp://o.canada.com/health/end-of-life-care-a-shift-to-living-well-before-dying
http://o.canada.com/health/end-of-life-care-a-shift-to-living-well-before-dying#commentsThu, 22 Jan 2015 18:30:10 +0000http://o.canada.com/?p=581785]]>Gerald “Jerry” Dill lay face down and semi-conscious on the operating table as the doctors drilled into his spine.

When cancer spreads to the vertebra, the bones become fragile and can collapse. Nerve roots coming out of the spine get pinched, causing serious pain. For Dill, the pain came in sudden and furious bursts. Pain that would hit “like a linebacker,” the 67-year-old says. Pain that shouted, “Here I am!”

In December, surgeons drilled into Dill’s crumbling vertebrae. Next they inserted a small balloon, re-expanded it and then injected bone cement into the bone, to keep it from collapsing again.

The relief, he says, was almost instantaneous. “I literally got up from the table and walked.”

In 2012, Dill began experiencing tightness in his chest. He thought he was having a heart attack. The diagnosis was terrifying and grim: stage four prostate cancer that had already spread to the bones.

Jerry Dill has stage four prostate cancer that has spread to his bones. He recently underwent cement injections into his spine to essentially keep it from collapsing. [Peter Power for Postmedia News]

Dill started a new round of chemotherapy Monday. He is also receiving palliative care, including pain control and psychosocial and spiritual support to deal with “my psychological and mental attitude towards things.”

“I’m dealing with it well, I’m a fighter,” he said. “But I’m learning not to get too far ahead of myself.” He worries about his teenage daughters, “my joy.”

“My kids are very well aware that this is a life-threatening disease and they spend time with me, they talk with me,” he says.

“They know that I can be out of here at any time,” says Dill, a man of strong faith. “I’m at God’s calling right now.”

For years, the philosophy was that patients with terminal illnesses received “active” treatment up until the very end, and only then were they offered palliation, or “comfort” care, in the final hours or days of life.

The push now is to provide palliative care sooner and include it with usual medical care.

“For all too many Canadians, that is the lingering memory they carry of their loved one’s death.”

The goal is to live well until dying, not hasten or postpone death.

More than 250,000 Canadians will die this year. The vast majority will not receive access to high quality palliative care in their home, hospital, or long-term care facility, because end-of-life care is being virtually ignored in discussions around health reform, even with a rapidly-growing aging population.

Demand for residential hospices, most of which rely heavily on charitable donations, is so great people are dying on gurneys in emergency rooms. Exhausted and emotionally drained caregivers often struggle to get the support they need to care for loved ones at home. Dying patients are languishing on hospital wards, simply because there is nowhere else to send them.

Jerry Dill who was photographed in his room at Princess Margaret Cancer Centre, is a husband, and father of two teenage daughters. His strong faith is helping him deal with an aggressive cancer that is causing considerable pain. [Peter Power for Postmedia News]

“In Canada right now if you’re at the end of your life and you haven’t been referred to a hospital-based palliative care program or a residential hospice, you are going to end up in hospital. It’s inevitable,” said Sharon Baxter, executive director of the Ottawa-based Canadian Hospice Palliative Care Association.

Before any change in law regarding euthanasia, the organization says every jurisdiction in the country should move swiftly to improve access to end-of-life care, including hospice care.

The goal of hospice care is to determine what’s important, and what is meaningful, when patients know that no heroic intervention is going to take away their disease.

“There are a lot of questions about, what’s going to happen next? Where am I going next? Is there a God? Is there reincarnation?’”

They are places that celebrate life through death, says Debbie Emmerson, director of Toronto’s 10-bed Kensington Hospice.

“We’ve had football parties here, we’ve had baby showers.” Some patients arrive at the hospice, the former chapel of St. John the Divine, in their finest outfits — full makeup and wig, or their hair done up. “They’re just trying their very best to be as dignified and normal as possible,” Emmerson said. The hospice has cared for prominent doctors and the homeless, for patients in their 20s to centenarians.

“There are a lot of questions about, what’s going to happen next? Where am I going next? Is there a God? Is there reincarnation?’” Emmerson said. “We don’t have those answers, but we can certainly sit and listen.”

They call it sitting with suffering — “creating this presence so that you know that you’re not totally alone in this journey that you are having.”

Elizabeth (Lynn) Douglas was moved to Kensington in March 2013. Lynn was a vice-president at the Princess Margaret Cancer Foundation, a role she took on after a long and successful private sector career. The day after she was admitted, the resident doctor went to Lynn’s room and introduced himself. “We chit-chatted for a minute, and then Lynn turned to him and said, “So, how is this going to go?” her husband, Cameron remembers. She applied the same attitude towards her diagnosis as she did to her career and life. “She was incredibly pragmatic about things.”

Lynn was first diagnosed with breast cancer in January 2010. She had chemotherapy and radiation but then the odds gradually started to build against her, and when it was gently suggested she and Cameron visit Kensington, they did so, “never imaging it would come to that,” Cameron remembers.

They decorated Lynn’s room with family photos, of Lynn with her wonderful boys, Scott and Todd. She had her favourite crossword puzzle pajamas and the stuffed animals friends gave her while she was in hospital. They kept her favourite, a lamb, with Lynn on her bed most of the time. They brought in a music therapist who played A Million Stars for Lynn on her violin.

Lynn spent five weeks at Kensington. As she grew sleepier and started to lose consciousness, Cameron and the boys kept telling her they loved her, and Lynn, when she could, said it back.

It was difficult for Cameron to watch Lynn’s body shut down, as she grew thinner. In the last week, he and his sons took shifts, sleeping in her room overnight. “We needed to be there, we needed to ride it out with her.”

Elizabeth (Lynn) Douglas’ favourite stuffed lamb they kept on her bed at the hospice when she was dying. (Supplied by family)

Lynn passed away on April 23, 2013, one day shy of her 64th birthday.

Early in her diagnosis, Lynn told Cameron that, “when life has meaning, all is worthwhile.” It helped her accept palliative care as the next, and final, step in her life, he said.

Yet research from B.C. suggests three-quarters of those who die are never identified as people who could benefit from end-of-life care.

Generally, patients require a life expectancy of three months or less to get referred. But for non-cancer diseases, such as advanced heart failure, dementia or chronic kidney disease, it’s difficult to predict when patients will actually die.

“So people with end-stage dementia or the very frail — they need bed lifts. They want to die at home. But there’s nothing out there (for them) if I can’t say with any certainty they’re going to die in three months,” says Dr. Ross Upshur, Canada Research Chair in primary care research.

“What happens is they get the runaround through the system and brutally treated. They get bounced through services, they get bounced in and out of hospitals and anybody who has an older parent that they’ve tried to get appropriate care for knows it,” Upshur says.

“We can do a lot for people at home, but they have to buy into a certain approach that they are opting not to have the high degree of intervention that can happen in a hospital.”

The Temmy Latner Centre for Palliative Care at Toronto’s Mount Sinai hospital provides round-the-clock, in-home care by doctors based not on life expectancy, but on need. Their palliative home care patients are less likely to be admitted to emergency in the last weeks of life, and less likely to die in hospital.

“We can do a lot for people at home, but they have to buy into a certain approach that they are opting not to have the high degree of intervention that can happen in a hospital,” said director Dr. Russell Goldman.

Chochinov believes good palliative care can address the fears driving support for euthanasia.

But others say there is some suffering even the best care cannot touch.

In a study published in September, researchers examined the frequency and intensity of symptoms in the last seven days of life among cancer patients who were able to communicate and who died in an acute palliative care unit. On a scale of “none” to the “worst possible,” patients scored symptoms such as pain, fatigue, nausea, depression and anxiety.

Despite intense care, some patients still suffered as they approached death.

For a small number of people, Upshur and others say, a better death will mean a doctor-assisted one.

Friday: Final Exit: How Quebec patients and doctors are preparing for legalized “medical aid in dying.”

]]>http://o.canada.com/health/end-of-life-care-a-shift-to-living-well-before-dying/feed3End of LifeskirkeyJerry Dill has stage four prostate cancer that has spread to his bones. He recently underwent cement injections into his spine to essentially keep it from collapsing. Jerry Dill who was photographed in his room at Princess Margaret Hospital, is a husband, and father of two teenage daughters. His strong faith is helping him deal with an aggressive cancer that is causing considerable pain.Elizabeth (Lynn) Douglas next to Paul Alofs, CEO of the Princess Margaret Cancer Foundation. (Supplied by family.) 0123 end of life IIOne dose, then brain surgery: Cancer study takes new approach to test drugs for deadly tumourshttp://o.canada.com/health/one-dose-then-brain-surgery-cancer-study-takes-new-approach-to-test-drugs-for-deadly-tumours
http://o.canada.com/health/one-dose-then-brain-surgery-cancer-study-takes-new-approach-to-test-drugs-for-deadly-tumours#commentsThu, 22 Jan 2015 18:19:37 +0000https://postmediacanadadotcom.wordpress.com?p=582383&preview_id=582383]]>By Marilynn Marchione

THE ASSOCIATED PRESS

Lori Simons took the bright orange pill at 3 a.m. Eight hours later, doctors sliced into her brain, looking for signs that the drug was working.

She is taking part in one of the most unusual cancer experiments in the nation. With special permission from the Food and Drug Administration and multiple drug companies, an Arizona hospital is testing medicines very early in development and never tried on brain tumours before.

Within a day of getting a single dose of one of these drugs, patients have their tumours removed and checked to see if the medicine had any effect. If it did, they can stay on an experimental drug that otherwise would not be available to them. If it did not, they can try something else, months sooner than they normally would find out that a drug had failed to help.

Time is everything for people with glioblastoma, the most common and deadly type of brain tumour, the kind that killed Massachusetts Sen. Edward M. Kennedy in 2009. Even when surgeons think they got it all, the cancer usually grows back and proves fatal. The few drugs to treat these tumors have little effect — median survival is about 14 months.

“We’ve had an endless string of failures” to find better ones, Sanai said.

His study is for people whose cancer came back. Doctors use a stored sample from the original tumour to see if its growth is driven by any genes or pathways targeted by one of the experimental drugs in development. If so, they give that single dose of the new drug before surgery to remove the new tumour.

Then, the tumour tissue is examined under a microscope to see if the drug had its intended effect on the genes or pathways.

In this Oct. 23, 2014 photo, nurse Norissa Honea holds a capsule of an experimental cancer drug being tested at Phoenix’s Barrow Neurological Institute. With special permission from the Food and Drug Administration and multiple drug companies, the Arizona hospital is testing medicines very early in development and never tried on brain tumors before. [AP Photo/Brian Skoloff]

So far, the study has tested one drug from AstraZeneca PLC in four patients. Another drug, from Novartis, will be added soon.

“We’re trying to develop a portfolio of these” so there are many possible drugs available for new patients under a single “umbrella” study, Sanai said.

It is called a “phase zero” clinical trial because it comes before the usual three-phase experiments to determine a drug’s safety, ideal dose and effectiveness.

“We view this as a great thing, as something that will produce better drugs that have greater chance of working,” said Dr. Richard Pazdur, cancer drug chief at the FDA.

“Cost potentially will go down and certainly time will go down” for companies testing new drugs this way and patients seeking something that will help, he said.

In the past, “if you had a new drug, you’d give it to a patient, you’d measure the blood levels, but very rarely would you have a way to know whether the presumed method of action was working in the patient,” he said.

Brain tumor patient Lori Simons, left, receives an experimental cancer drug from nurse Norissa Honea at Phonenix’s Barrow Neurological Institute in this photo made on Oct. 23, 2014. Simons is taking part in one of the most unusual cancer experiments in the nation. With special permission from the Food and Drug Administration and multiple drug companies, the Arizona hospital is testing medicines very early in development and never tried on brain tumors before. [AP Photo/Brian Skoloff]

The Arizona study gives a way to check that, because the tumour is removed right after the first dose is given. And if the drug does not work in any or few of the people who get it, the study could spare others a futile treatment, and limit the time and money a drug company invests.

“If you’re going to fail, you want to fail early and fail fast before you put thousands of patients into randomized trials,” Doroshow said.

The experimental drug did not appear to help Simons, a 55-year-old former pharmacist from Gold Canyon, an hour’s drive east of Phoenix. Doctors decided to try an older drug, Temodar, after her surgery in late October.

“The real interest in these kind of trials is not necessarily putting patients on these drugs but keeping them off drugs that aren’t going to work,” said Sanai, who treated Simons.

The patient said she had no regrets about participating.

“It’s a revolutionary trial. I think it will open up a pathway for many other drugs to be studied in this manner,” Simons said. “I go into this with no motive for me. It’s just for the future, people who have cancer like I do, and see what kind of treatments they can have.”

]]>http://o.canada.com/health/one-dose-then-brain-surgery-cancer-study-takes-new-approach-to-test-drugs-for-deadly-tumours/feed0Brain-Tumors.jpgtheassociatedpresscanadaIn this Oct. 23, 2014 photo, nurse Norissa Honea holds a capsule of an experimental cancer drug being tested at Phoenix's Barrow Neurological Institute. With special permission from the Food and Drug Administration and multiple drug companies, the Arizona hospital is testing medicines very early in development and never tried on brain tumors before. (AP Photo/Brian Skoloff)Brain tumor patient Lori Simons, left, receives an experimental cancer drug from nurse Norissa Honea at Phonenix's Barrow Neurological Institute in this photo made on Oct. 23, 2014. Simons is taking part in one of the most unusual cancer experiments in the nation. With special permission from the Food and Drug Administration and multiple drug companies, the Arizona hospital is testing medicines very early in development and never tried on brain tumors before. (AP Photo/Brian Skoloff)End of life care: doctors, machines and technology can keep us alive, but why?http://o.canada.com/health/end-of-life-care-doctors-machines-and-technology-can-keep-us-alive-but-why
http://o.canada.com/health/end-of-life-care-doctors-machines-and-technology-can-keep-us-alive-but-why#commentsWed, 21 Jan 2015 19:30:38 +0000http://o.canada.com/?p=580470]]>Before starting medical school, James Downar believed that doctors have a moral duty not to let patients die without doing everything to keep them alive. Then he started to experience how lives actually ended.

Many deaths were peaceful. Many were not. He witnessed patients dying of lung cancer who suddenly began coughing up blood, drowning before they could be injected with morphine to relieve their distress.

He observed the older man with advanced liver cancer whose wife kept insisting on aggressive care even though he clearly was dying. The man was admitted to the intensive care unit with cancer-related pneumonia, and then developed a catastrophic bleed in his stomach. His body swelled from repeated ineffective blood transfusions, his kidneys shut down and he never regained consciousness. He died without saying goodbye to his children.

“You cannot see these deaths and not be moved. They are just so unnecessary,” says Downar, a critical- and palliative-care doctor at the University Health Network in Toronto. “We had every opportunity to intervene and provide these patients with better end-of-life care, and prepare their families for what was inevitable.”

In the first of a three-part series on how we could end our lives better, Postmedia News explores the reality of death today, when technology allows hospitals to stretch a patient’s last days longer and longer — with questionable results.

“Bad deaths” happen because of an unwillingness to confront that, fundamentally, most diseases cannot be cured, Downar says. They happen because doctors, untrained and profoundly uneasy confronting our deepest fears and anxieties, see death as a failure, and it can sometimes be easier to continue with aggressive treatment than to tell a patient or family, “I can’t turn this around.”

Dr. James Downar, a critical-care and palliative-care physician in Toronto, poses for a photograph in the ICU. (Matthew Sherwood for Postmedia News)

They happen because difficult conversations aren’t happening until there is a crisis and families are in such emotionally hot states they cannot think, concentrate or hear properly.

More than 259,000 Canadians take their last breath each year. By 2036, the number will grow to more than 450,00 as the population ages.

Yet most lives do not end suddenly, meaning many people can, if they choose, plan the circumstances of their deaths, and tell their doctors and families what they want, or want to avoid.

One option may soon be legalized euthanasia. The Supreme Court of Canada is on the verge of issuing a landmark ruling into whether Canadians have the constitutional right to assisted suicide — a right Quebec is already preparing to grant terminally ill, competent adults experiencing “unbearable” suffering.

“The fact that you’re dealing with death means that somehow you can’t make the patient better, you can’t control. And some people are fundamentally afraid of that.”

But even in jurisdictions where assisted suicide is permitted few people request it and, among those who do, many never go through with the act.

“Physicians are taught from the beginning to diagnose and treat, to diagnose and cure, to diagnose and make better, or at least control,” says Dr. Angela Genge, director of the ALS clinic at the Montreal Neurological Hospital.

“The fact that you’re dealing with death means that somehow you can’t make the patient better, you can’t control. And some people are fundamentally afraid of that.”

Advances in medicine and fund-raising slogans about “winning the war on cancer” have led to unrealistic expectations about what medicine can and cannot do. The expectation often is: you can fix this. It’s like the resurrection of Lazarus, says Derek Strachan, a spiritual care professional at the Toronto General Hospital.

“We can do amazing things, and we’ve been surprised. We’ve had people walk out of here that we would never have thought would,” Strachan says. “But it creates this expectation that we are miracle workers. And when we can’t perform miracles, it’s tough.”

Pat and Ken Hillcoff had discussed what they would or would not want if faced with a terminal illness. Ken’s father died of ALS. Pat’s mother died of a heart attack when she was 65. They had conversations about never wanting to be kept alive on machines, never wanting to be dependent on others.

“In a black and white world, it’s easy to say you don’t want those things,” Ken said. “But in Pat’s case, nothing was black and white. It was all grey.”

Pat was 57 when she was diagnosed with pulmonary fibrosis — deep scarring in her lungs. The retired primary school teacher was told her she would die without a double lung transplant.

She was sent home on oxygen and waited 14 months for her new lungs. The operation took eight hours. She would spend the next 180 days in intensive care fighting not to die. Her body battled furiously against the new organs. She developed infections and her chest wound had to be kept open for four months to treat the area and debride the bones. Ken saw his wife’s heart beating inside her chest. One day, when the surgeon moved the organs to get to where he needed, he told Ken, “Now two men have touched Pat’s heart.”

Miraculously, Pat rallied. But her kidneys had shut down and so four afternoons a week Ken connected Pat to a dialysis machine, hooking the dialysis tube to the thick, central line that went into Pat’s heart and exited up near her left breast.

In all, she would spend 300 days in intensive care. Ken was there for 299 of them. “Each morning, the doctors would start their rounds, with, ‘Today is day number ‘fill in the blank.’ This is Pat.”

Ken Hillcoff inside his Markham home where he lived with his wife, Pat, before she passed away on April 15, 2014. The photograph is of the two of them during a cruise. [Peter Power for PostMedia News]

Pat was eventually discharged home. She lived another 24 good and meaningful months on dialysis. Then, in early spring 2014, she was diagnosed with breast cancer. The doctors told her she would not survive surgery, but they offered radiation. She developed an overwhelming infection and spent her last six weeks of life in hospital, confined to bed. On the evening of April 14, Ken kissed Pat goodbye as the nurses connected her to the dialysis machine. “Love you, see you in the morning,” he told her.

Pat died the next morning, before Ken could get back to the hospital. She was scheduled for more radiation that day.

Ken believes Pat’s doctors did everything they could. “She was stubborn — she would call it tough. In the ICU, I never had the idea ‘you shouldn’t really be doing this,’ because you’re hopeful.”

The end wasn’t what Pat had hoped for. “Any death in the hospital is going to be bad, and she suffered a little at the end,” Ken said. He can’t remember being approached to discuss Pat’s wishes, until death was near. “There were so many doctors involved. I could see that it would be easy for someone to think, well, someone else must have discussed this with the family. So nobody ended up talking about it.”

Pat Hillcoff, a Toronto-area woman, died last April at age 62 having survived a double lung transplant, only to be stricken with breast cancer. (Credit: family handout)

Most of us want to die at home, surrounded by families. The reality is 70 per cent of us will die in a hospital and of those who do, 10 to 15 per cent will be admitted to an ICU. Most Canadians have no written plans about what life-prolonging treatments they would accept or reject, and fewer than half have designated a substitute decision maker to speak on their behalf if they became incapacitated.

Doctors say some families are clear: “My mother would never have wanted this.”

“But some families are absolutely adamant that life-sustaining interventions not be withheld or discontinued,” says Dr. Christopher (Chip) Doig, professor and head of the department of critical care medicine at the University of Calgary.

Many have not fully grasped what they are asking for.

“When I do CPR on somebody I can assure you that I will break their sternum and their ribs,” says Doig, who can often feel the bones cracking beneath his hands during deep chest compressions.

Most patients on ventilators need to be sedated so they don’t try to pull the breathing tube out. The tube burns; it can feel as if someone is pushing a gloved finger down his or her throat. They cannot talk. They cannot eat by mouth. And they need to be suctioned, which involves taking them off the ventilator. They can feel as if they are suffocating. Some patients require suctioning 40 to 60 times a day.

Patients have tubes in almost every orifice — a bladder catheter, a rectal tube, a feeding tube, arterial lines in their groins or wrist, central lines under their collarbone into the main blood vessels close to the heart.

When the interventions seem futile, when none of it is likely to change the “outcome,” the distress on staff can be profound.

ICU nurses provide one-on-one care. They talk not just about their patients, but “my families.” Nurses say there can be few things more distressing than when an unconscious patient grimaces, or reaches out for them, when they are being turned.

They are often the first team members to feel that life-support should be withdrawn.

Denise Morris is the nurse manager for the medical/surgical intensive care unit at Toronto General. [Peter Power for Postmedia News]

“Sometimes the nurses are already at the place, thinking, ‘we need to have a family meeting, we need to have some end-of-life discussions here,’ but it may not be on the family’s radar,” said Denise Morris, nurse manager of the medical/surgical ICU at Toronto General Hospital.

“And I think that piece, that waiting for the families to decide, is difficult, because the question in their head is, are we actually doing harm for our patient? Are we prolonging the dying process, rather than prolonging life?”

Without prior conversations or advanced directives, when families have to decide about withdrawing or stopping treatment the choice can be agonizing.

“Families tell us that kind of decision-making is really distressing to them. ‘Don’t ask me to make that decision to take my dad off the vent. I can’t do it,’ ” Morris said.

Experts say that too often the communication focuses on what will not be done — “we should remove the life-support” — which often only provokes the response, “you can’t stop.” Instead, Downar says the emphasis should be on switching from “curative” or life-prolonging care, when there is no hope for recovery, to “comfort” care.

Ottawa oncologist Dr. Shail Verma says when patients trust that everything that can be tried has been tried, the response is often, “I’m exhausted. I would rather focus on the quality of my life and the end of my life.”

But when something has always worked, when a patient with widespread cancer has been saved again and again, “when finally something else happens and you say, ‘the barrel is empty, there’s nothing more to give,’ there can be this disbelief,” Verma said.

“I think the climate today is, ‘there must be something.’ And so inadvertently patients who have incurable catastrophic presentations of cancer still end up on ventilators, they still end up in ICU settings for weeks, until someone has the courage to say, ‘this will never get better.’

“Often times patients are already there, and we’re the ones struggling to catch up.”

Many experts are pushing for more training for doctors on how to handle with skill and delicacy end-of-life discussions with patients.

It’s a conversation doctors dread the most, says Dr. Heather Ross, a cardiologist at the Peter Munk Cardiac Centre and one of the top transplant specialists in the country. “I think it’s just an incredibly difficult thing to do. Trying to find a way to tell somebody that they’re dying but not remove hope so that there is something for them to hold on to is a very big challenge.”

Ross focuses on her body posture and eye contact. If the patient is in bed, she sits. If he’s bolt upright, she stands. Her hands are never in her pockets; her arms are never folded across her chest. She gauges how the patient is taking in the information. Do they accept? Keep going. They don’t accept? Pull back.

“Often I have a very long and established relationship with these patients. I will look them in the eye and tell them that, unfortunately, there isn’t any other treatment I can offer, and that we’re in trouble. Real trouble,” Ross says.

“Oftentimes patients are already there, and we’re the ones struggling to catch up.”

Ross says everyone deserves the right to a dignified death — to be comfortable, to bring closure if needed to issues with family or friends, where caregivers and families aren’t abandoned and people ultimately do not suffer.

Polls supporting euthanasia suggest many of us fear our last moments on earth. Quality, end-of-life care could give more Canadians a gentle exit from this world, Harvey Max Chochinov, a professor of psychiatry at the University of Manitoba, writes in a recent commentary in the journal, HealthcarePapers. But today in Canada, the chance of getting such care often comes down to a “crapshoot,” Chochinov says. “Is it any wonder that people are so afraid?”

Tomorrow: Living while dying: How to improve the quality of life until the last breath.

Advance Care Planning in Canada’s Speak Up Campaign (www.advancecareplanning.ca) suggests five steps for creating an advance care plan — instructions to help guide a substitute decision maker about the kind of care you would or would not want if faced with a life-threatening illness:

Think about what’s right for you. What’s important to you about your care?

Learn about different medical procedures, such as dialysis, CPR, tube feeding and breathing machines. Some may improve your quality of life while others may not.

Choose a substitute decision maker who is willing and able to speak for you if you can’t speak for yourself.

Experts say it is important to choose a substitute decision maker who is prepared to carry out your wishes. “People have a very hard time putting their own beliefs and values aside, because we’re not built like that, emotionally or psychologically,” says Dr. Russell Goldman, director of the Temmy Latner Centre for Palliative Care at Toronto’s Mount Sinai Hospital, Canada’s largest home visiting palliative program.

For Goldman, “it’s all about reversibility — what are my chances of having a decent quality of life?

“If I had to give direction to someone who is making decisions for me, it would be, ‘I can go to the ICU for a little while, if you think I’m going to recover and get better. But if you think I’m not going to recover, and I’m not going to get better, if my quality of life is going to be so diminished, call it off, and call it off quick.’ ”

(Source: Advance Care Planning in Canada Project)

]]>http://o.canada.com/health/end-of-life-care-doctors-machines-and-technology-can-keep-us-alive-but-why/feed6JamesDownar03.JPGskirkeyDr. James Downar, a critical care and palliative care physician at Toronto General Hospital, poses for a photograph in the ICU. (Matthew Sherwood for Postmedia)Ken Hillcoffinside his Markham home where he lived with his wife Pat before she passed away on April 15, 2014. The photograph is of the two of them during a cruise together before Pat got sick. Pat in Golden Chair.JPGDenise Morris is the nurse manager for the medical/surgical intensive care unit at Toronto General Hospital.Pizza isn’t great for growing bodies, just in case you needed a study to tell you thathttp://o.canada.com/health/diet-fitness/pizza-isnt-great-for-growing-bodies-just-in-case-you-needed-a-study-to-tell-you-that
http://o.canada.com/health/diet-fitness/pizza-isnt-great-for-growing-bodies-just-in-case-you-needed-a-study-to-tell-you-that#commentsTue, 20 Jan 2015 16:17:51 +0000https://postmediacanadadotcom.wordpress.com?p=580845&preview_id=580845]]>By Nicole Ostrow

Go ahead, give your kids pizza. Just maybe not so much of it.

A new study found that American children take in more calories, fat and salt on days that they eat pizza. That’s not necessarily because it’s worse than a burger or a side of fries. It has a lot to do with the way pizza lends itself to snacking – – and overindulging.

When pizza was on the menu, kids ages 2 to 11 years consumed 84 more calories and 134 more milligrams of sodium than on days they didn’t eat the food, while teens took in an extra 230 calories and 484 milligrams of sodium, research published today in the journal Pediatrics showed. They all also consumed more saturated fat.

Hopefully we can make healthy pizza the norm

About 20 percent of kids eat pizza on any given day, and it’s their second-highest source of calories behind desserts like cake and cupcakes, the authors said. So parents should try to avoid giving pizza between meals as a snack. And if it’s served as a meal, it should be made with healthier ingredients and supplemented with salad or other vegetables and lean proteins in a bid to limit the number of slices consumed, Powell said.

“This is not saying don’t eat pizza,” said Powell, a professor of health policy and administration at the University of Illinois at Chicago. “It’s a nice opportunity for us to make some small changes because it’s such a prevalent item in children’s diets. Hopefully we can make healthy pizza the norm.”

U.S. pizza purveyors say they’re on board with that. Domino’s Pizza Inc., one of the top pizza chains, has introduced slices for school lunch programs made with whole white wheat crust and lower fat and lower-sodium cheese and pepperoni, company spokesman Tim McIntyre said in an e-mail. He said Domino’s has provided online nutritional information for more than 14 years.

“We constantly look for ways to make our products ‘better’ without sacrificing taste,” he said. “This is an ongoing initiative.”

Pizza Hut has introduced new products, like the low-calorie Skinny Slice. “We take health and wellness very seriously, and believe that every item on the Pizza Hut menu can be part of a balanced diet,” said Doug Terfehr, a spokesman for the chain owned by Yum! Brands Inc.

The researchers examined data on children ages 2 to 19 years who participated in the National Health and Nutrition Examination Survey between 2003 and 2010. More than 6,000 were asked to recall their diets over the past 24 hours on two nonconsecutive days, Powell said.

The study found that on days pizza was consumed as a meal or a snack, it made up more than 20 percent of total daily calories. When it was a snack, children ate an extra 202 calories and teens an additional 365 calories compared with days they snacked on other things. A moderately active child needs about 1,500 calories a day and a teen should have about 2,000. Sodium for both groups should be limited to about 2,300 milligrams, said Lisa Powell, the lead author of the study.

“As with everything, you have to consider moderation,” said Everett, who wasn’t involved in the study. “Pizza should be a once-in-a-while type of food.”

]]>http://o.canada.com/health/diet-fitness/pizza-isnt-great-for-growing-bodies-just-in-case-you-needed-a-study-to-tell-you-that/feed0Homemade pizza tastes better than anything you can buy and it takes much less time and effort than you would think.bloombergcanadaRonan Cleary enjoys a pizza at Centreville Amusement Park in a file photo. (Lasia Kretzel/National Post) Men need life mentors toohttp://o.canada.com/life/men-need-life-mentors-too
http://o.canada.com/life/men-need-life-mentors-too#commentsTue, 20 Jan 2015 12:00:41 +0000http://o.canada.com/?p=578201]]>You may think men are obsessed with Star Wars because of the epic battle scenes. But in truth, we guys still dream of meeting a little green Yoda who can bring out our full potential, like making spaceships move with our minds.

Joking aside, January is national mentorship month. Much of the media focus is understandably on helping at-risk youth make better life decisions, along with an important conversation on empowering women to climb the career ladder. But we wonder, what about life mentors for men?

There are very few university courses that focus on how to be a good husband or father, how to balance work and family life, or how to approach mid-life crises without quitting our jobs to travel the world. And few of us have the benefit of being in a book club where more than literary wisdom is exchanged.

“Every single man deals with self-doubt at some point in his life,” says Dale Thomas Vaughn, president of the Global Center for Healthy Masculinities in California. In a recent conversation he told us, “this fear keeps us stagnant and isolated” unless we find someone who believes in us and motivates us to move forward. “Even the toughest guys I know are relieved to have someone safe to go to for advice and a pep talk,” adds Vaughn.

“Every single man deals with self-doubt at some point in his life.” — Dale Thomas Vaughn

In our lives, that someone is our trusted friend David Baum. David has impressive credentials, with PhDs in both organizational psychology and divinity, and he’s a well-rounded guy. David mentors CEOs, political figures and non-profit leaders — often on canoe trips in the wilderness. And he counsels equally on strategic planning and personal growth.

On long walks with David, we cover everything from staffing strategies to our work-life balance and relationships. We always walk away with several light bulbs above our heads and several loads off our shoulders.

If you’ve got a man in your life who could use a little mentorship (and let’s face it, we all could), here are five tips from experts to help him find his personal Yoda:

1. Ask empowering questions. Men like to feel in charge of their lives, says Vaughn, so avoid suggesting solutions. Instead, talk to your man about where he wants to go in his life and then ask, ‘Do you know anybody who can help you get there?’ Even if he doesn’t, he’ll start to think about reaching out.

Sports help to bring men together and offer an opportunity for life mentorship. Frank Gunn

2. Remind your guy to seek the Yodas in his midst. “Mentors are all around us,” says Wayne Townsend, founder of the online group PeerMentor.net in Kitchener, Ont. “Everybody I’ve ever asked for advice, or to shadow at work for a day, has always said yes.” Vaughn recommends scouring online networking sites. “There’s somebody on LinkedIn for every profession, hobby or issue out there,” he promised us. “And people will respond to you because they’re itching to share their expertise.”

3. Encourage time with the guys. Like many men, we’ve each benefited from a close group of guy friends we feel safe with. Craig’s “support group” comes from his MBA program. After two years of late-night study sessions ended, six friends stay connected through regular get-togethers, where they brainstorm advice for each other about business and life challenges. They’ve stood together at weddings, helped each other through health scares and developed a brother-like trust.

4. Encourage community of any kind. Regular, organized activities — volunteering, sports, service clubs — offer encounters with new people your guy can learn from. There are also formal men’s mentoring groups known as “Men’s Sheds” in Winnipeg, and Kelowna, Hope and Pemberton, BC. You can find local chapters of the peer mentorship group ManKind Project across Canada, and also online groups — like Vaughn’s EmpowerMentorship.com — that connect men from around the globe.

5. Get your guy to start his own men’s group. Suggest the man in your life invite a group of male friends to go cycling on Saturdays or some other casual activity. “We all know poker groups aren’t about poker,” Vaughn reminded us.

Brothers Craig and Marc Kielburger founded a platform for social change that includes the international charity Free The Children, the social enterprise Me to We and the youth empowerment movement We Day.

]]>http://o.canada.com/life/men-need-life-mentors-too/feed0Star Wars Episode V: The Empire Strikes BackcraigkielburgerSports help to bring men together and offer an opportunity for life mentorship. PRESS/Frank GunnThis week in health: Flu shot debated, risk profiles questioned, and morehttp://o.canada.com/health/this-week-in-health-flu-shot-debated-risk-profiles-questioned-and-more
http://o.canada.com/health/this-week-in-health-flu-shot-debated-risk-profiles-questioned-and-more#commentsFri, 16 Jan 2015 20:09:55 +0000http://o.canada.com/?p=579068]]>Canada.com takes a look at a few stories you may have missed this week.

Carroll seems to be taking issue with the notion that this year is a “bad” year for the shot. This is perhaps an unfair conclusion, since this year’s numbers aren’t really that much worse than they have been in supposedly “better” years. “The difference in the percentages here were 49% of those with flu were vaccinated versus 56% of those without flu were vaccinated,” he says. “That’s a bad year. In a good year – say 2013, the numbers were 32% and 56%. That yields an effectiveness of 62%. But even in a good year, one third of people who were influenza positive were vaccinated!”

Are doctors over-emphasizing risk factors for diseases – and over-treating people as a result? [pkchai/Fotolia.com]

You likely hear a lot of stories about whether you’re at a higher risk for one disease or another. Perhaps you’ve gone to your doctor, only to be told you have a higher risk profile for heart disease, cancer, or something else. It’s common medical practice these days to assess these risks and prescribe a range of preventative therapies; but, as Jeff Wheelwright argues in Aeon, we may be over-treating people for diseases they likely will never get.

The problem, Wheelwright says, is rooted in the proliferation of “risk calculators” in modern medical practice. “Risk factors have acquired an unwarranted power,” he says. “Doctors try to manage them as if they’re the disease itself and, as a result, patients are subjected not only to undue worry but also to the harmful side effects of preventive medications and testing.”

To an outside observer, the notion that a new mom can take as much as a year off work to care for their baby may seem like a pretty sweet arrangement. “Really? You get to sit around and do nothing all day, for months on end?” But those who have experienced first-hand would likely see things differently. It’s not by any means a vacation. And Belinda Luscombe, writing in Health.com, hopes to set the record straight on this issue once and for all.

One way to think of it, she says, is as a sort of “job swap”: parental leave doesn’t mean putting one job aside to do nothing. Rather, “The new parents are swapping the jobs they know for shift work in an excrement-making factory with a co-worker who cannot communicate except by weeping or kicking. Plus, the shift never ends. And the chances of promotion are zero.” She takes aim in particular at the shockingly inadequate U.S. laws: they’re the only western country that doesn’t have federally-mandated maternity leave. See video above for further moral outrage.

]]>http://o.canada.com/health/this-week-in-health-flu-shot-debated-risk-profiles-questioned-and-more/feed0FludavidkatesFluDo you feel you get enough face time with your doctor? (Photo: pkchai/Fotolia.com)Staying fit in winter: Keeping active in the new year without resolutionshttp://o.canada.com/health/diet-fitness/staying-fit-in-winter-keeping-active-in-the-new-year-without-resolutions
http://o.canada.com/health/diet-fitness/staying-fit-in-winter-keeping-active-in-the-new-year-without-resolutions#commentsFri, 16 Jan 2015 15:26:15 +0000http://o.canada.com/?p=578412]]>Now that a new year is upon us, fitness clubs are teeming with guilt-filled patrons. But few will stick to their routines. For many more of us who perhaps want to start one but don’t feel we have the time, perhaps there’s an alternative that doesn’t involve ponying up for a gym membership – or even dedicating time just for a workout. Is there a better way to get in shape in January?

In fact, maybe we shouldn’t worry about setting lofty goals for ourselves starting on what’s essentially an arbitrary date. While starting something at the stroke of a new year may feel like a fresh start, the fact is that neither the act of making a resolution, nor the goals it typically entails, are practical or even necessary for a healthier lifestyle.

Speaking in the New York Times recently, Ryan Rhodes, a professor of behavioural medicine at the University of Victoria, said resolutions often fail because the goals themselves aren’t really achievable in the first place. “People who intend to exercise a lot, such as four or more times a week, are more likely not to meet those intentions,” he says.

According to Rhodes, people need to be realistic. Don’t plan an early-morning, high-impact workout if you’re not typically an early riser; forcing yourself to get up before 6:00 a.m. isn’t a sustainable routine. He suggests thinking about the obstacles preventing you from exercising, and removing as many as possible: pack your gym bag the night before, plan workouts at times when you have the most energy, and keep to those times until they become habitual.

Another problem is our motivation to exercise is easily derailed by counter-motivations. A 2011 study suggests it’s not simply a lack of motivation to get in shape that hurts these efforts; it’s the excuses that keep us from maintaining a new routine. According to exercise psychology expert and trainer Dan Shaw, we’re quick to come up with reasons to avoid exercise, whether we’re trying to get more done at work, avoiding anticipated pain, or preferring to spend that time with friends and family.

These motivations aren’t things that will go away, of course. Like Rhodes, Shaw also identifies the need to identify these obstacles and design a routine that accounts for them; otherwise, there will always be reasons to avoid a workout.

Walking is an underrated form of exercise, and probably the easiest one to fit into your schedule. According to the American Heart Association, there are lots of ways to get your required exercise through walking, even if it’s in 10-minute bouts throughout the day. Take a half-hour walk outside during your lunch break if you can, or in the evening after work. If it’s too cold outside, consider a walk through a large indoor space like a shopping mall. If possible, take transit to work and leave the car at home; it may be an opportunity to get some walking into your daily routine, especially if there’s some distance between your home or workplace and the nearest transit stop.

If you want a more rigorous workout but don’t want to take it to the gym, home workouts can be just as beneficial. “A workout DVD or even a quick YouTube search to find indoor aerobic routines can pay off when you have limited space,” writes Michael Andrew in Active.com. “If you have weights, resistance bands, a skipping rope, a stability ball, trampoline, or other equipment, you can incorporate those into a great full body workout.”

Making the best of winter

Skiing: both a great winter sport and a good excuse for a trip. [AP Photo/Rick Bowmer]

Perhaps we’re missing a greater point here: there are, of course, a variety of winter activities that both allow us to enjoy the season and stay in shape. The best part is that many of them double as opportunities to get out with friends or spend quality time with family. There’s really no need to hit the gym when there are so many better options out there during the colder months.

Skiing, while it may require some planning to get to the slopes and some investment in equipment and access, is both a great winter sport and the perfect excuse for a weekend trip. Cross-country skiing and snowshoeing, while perhaps less exhilarating than downhill, are both highly rewarding endurance activities that provide an excellent way to take in some breathtaking winter scenery.

For those who might not be able to travel to a ski hill or cross-country course, skating may be a more affordable and accessible option. Check your local ice rink for free skate times. Or, if you have kids, sign them up for lessons.

Whatever the activity, the key should be to enjoy what we’re doing and not feel like we’re dragging ourselves around.

]]>http://o.canada.com/health/diet-fitness/staying-fit-in-winter-keeping-active-in-the-new-year-without-resolutions/feed0snowshoeing_montreal1024davidkatesSkiing: both a great winter sport and a good excuse for a trip.A role model of resiliencehttp://o.canada.com/life/an-extraordinary-tale-of-resilience-and-forgiveness
http://o.canada.com/life/an-extraordinary-tale-of-resilience-and-forgiveness#commentsTue, 13 Jan 2015 12:00:28 +0000http://o.canada.com/?p=575262]]>Amanda Lindhout spent 460 harrowing days in captivity in Somalia. Her survival is extraordinary — even more so is what unfolded upon her return. This resilient woman has emerged as a role model for compassion, a true humanitarian.

Six years ago, the then 27-year-old freelance journalist was eager to tell stories from the harshest corners of the world. While driving outside of Mogadishu — one of the earth’s most dangerous cities — Lindhout was kidnapped by Islamic extremists. She was chained, routinely raped, brutalized, and moved about to a series of windowless rooms. She relived this dark world of submission and terror in her best-selling book, A House in the Sky.

After her release — more than a million dollars ransom was raised by her working-class family — Lindhout could have denounced Islam, to which she converted in Somalia, simply to survive. She could have turned her back on Somalia. She could have used her book’s success to establish the media career she sought before her kidnapping. She could have taken the book’s profits and the money she is making from an upcoming movie deal and led a relatively low-key life. All of this would have been understandable, given what Lindhout endured.

Instead, Lindhout forgave her captors. She strongly believes poverty and a lack of formal education are the seeds from which extremism grows and are vital issues that still desperately need solutions. She speaks about the people of Somalia with respect, not anger. Perhaps most extraordinarily, she has returned to the country five times since her negotiated release from captivity to help its people through the Global Enrichment Foundation, which she founded in 2010.

Since her release from captivity in Somalia, former journalist Amanda Lindhout has made several humanitarian trips to back to the African nation, and devotes her life and money to the alleviation of suffering among others. Her best-selling book, A House in the Sky, has been optioned for a film. Handout

In addition to working with her foundation and taking on a consulting role on the movie version of A House in the Sky, Lindhout yearns to go back to school so she can give back in new ways.

“I want to study psychology,” she told us. “If I was to become a practicing clinical psychologist, I could take what I have been through and help other people.”

When we recently sat down with Lindhout she shared five lessons on forgiveness, happiness and making the most of our potential. Here’s what we discovered:

Forgiveness isn’t an ‘a-ha’ moment — it takes a lot of work. “It’s a long process and it well may be for the rest of my life. I have to make the choice every day to come to a place of understanding about my captors and find compassion for them that allows me to forgive. Some days, it’s a struggle.”

Don’t let circumstance hold you back. “I grew up in what poverty in Canada looks like — in a basement apartment where we didn’t have two cents to rub together. I had to learn how to be a survivor. Coming from nothing, I learned about hanging on to your dreams. For me, that was about being out and exploring the world, which I did and continue to do.”

Learn from your mistakes. “I have been criticized since I came home from captivity in Somalia. I was a young woman when I went there and I did make some naive decisions. I can recognize the mistakes I made and would do things differently today.”

We can choose to be resilient. “It’s innate in all of us. When times of crisis occur, we have a choice to grab on to that resilient nature of ours and to nurture it, or slide into despair. On a daily basis, I chose to hold on to the resilient part of myself — and what we hold onto grows.”

Treasure the little things. “I had a rare opportunity to have a second chance at life and I really appreciate small moments now, like a hug from my mom. I live in Canmore, Alberta and I love going outside and looking up at the big, blue sky and the mountains. These were things I took for granted before they were taken away from me for so long.”

Brothers Craig and Marc Kielburger founded a platform for social change that includes the international charity Free The Children, the social enterprise Me to We and the youth empowerment movement We Day.

]]>http://o.canada.com/life/an-extraordinary-tale-of-resilience-and-forgiveness/feed2craigkielburgerCNSPhoto-JOURNALIST-KIDNAPResearchers advise pregnant women to limit exposure to receipts and plastichttp://o.canada.com/news/national/researchers-advise-pregnant-women-to-limit-exposure-to-receipts-and-plastic
http://o.canada.com/news/national/researchers-advise-pregnant-women-to-limit-exposure-to-receipts-and-plastic#commentsMon, 12 Jan 2015 21:26:44 +0000http://o.canada.com/?p=576576]]>Pregnant women are being warned to avoid reaching for credit card and cash register receipts as the ubiquitous bits of paper are increasingly seen as a threat to unborn children.

The receipts can contain the toxin bisphenol A and its chemical cousin bisphenol S, chemicals that a new study shows can alter brain development and behaviour in animals exposed to extremely low doses.

The research published Monday by a team at the University of Calgary was done on zebrafish. But the findings are so worrying lead researcher Deborah Kurrasch and her colleagues are calling for “removal of all bisphenols from consumer merchandise.”

They also “suggest that pregnant mothers limit exposure to plastics and receipts ” — a recommendation that is being echoed by other researchers familiar with the power of the endocrine-disrupting chemicals.

The greatest risk is in the second trimester when infant brains are rapidly growing and would be most vulnerable to the ill effects of bisphenol A, or BPA, and Bisphenol S, BPS, which has been widely used to replace BPA.

The chemicals can have “real and measurable effects on brain development and behaviour,” the researchers report in the Proceedings of the National Academy of Sciences. Their experiments on embryonic fish found minuscule doses of the chemicals — far below levels deemed safe in Canada — stimulate excess growth of neural cells associated with hyperactivity.

BPA is used to harden plastic and is found in plastic containers, the lining of cans, and on the thermal paper that is used to produce everything from credit card receipts to theatre tickets. As concern about BPA has grown, it is increasingly being replaced by BPS which the study says is just as bad.

It “equally affects neurodevelopment,” says the study, that adds to mounting concerns about the chemicals that can leach into food and rub off receipts. Health Canada surveys have shown that 95 per cent of Canadians have trace amount of BPA in their urine, with the highest levels seen in children.

BPA are endocrine disrupters that have been linked to obesity, cancer and childhood neurological disorders such as anxiety and hyperactivity. Previous studies suggesting that BPA may affect brain development prompted Canada and some other countries to ban the chemical’s use in baby bottles and phase out its use in baby food containers.

Kurrasch and her colleagues say regulators need to go much further.

Their work on embryonic zebrafish found very low doses – “1,000 fold lower than the accepted human daily exposure” of BPA – lead to overproduction of neural cells in the hypothalamus, a region of the brain involved in hyperactivity.

“What we show is that BPA affects the timing of when neurons are born, and that presumably alters circuitry in the brain, so you get this slightly different wiring,” Kurrasch said in an interview. She is a developmental neuroscientist who studies how changes in the brain in early life can impact later life.

The team first exposed the fish to an extremely low dose of BPAcomparable to a level that has been measured in the Oldman River, which provides drinking water to the city of Lethbridge, Alta.

Kurrasch says she didn’t expect to see an effect at such a low dose, but embryos exposed for less than a day hatched into larvae that were much more active swimmers than normal zebrafish.

“I was very surprised,” Kurrasch says.

While fish are not humans, she says the way neurons form early in life is very similar “whether you are fish, or a mouse or a human.”

“The same series of steps lead to brain development,” she said.

While humans aren’t swimming in water contaminated with BPA and BPS, she says people “are exposed to these chemicals every day in terms of things we touch and foods we consume.”

And the doses the team linked with neural effects in the zebrafish were much lower than levels that have been measured in women’s placentas and serum taken from fetuses.

She is also concerned that manufacturers have turned to BPS with “little proper toxicology” as an alternative when producing the “BPA-free” products.

Given the findings that BPA and BPS are both harmful, the researchers say “a societal push to remove all bisphenols from our consumer goods is justified.”

Other researchers share their concern.

“That BPA and BPS produce similar effects is not surprising given their structural similarity but dismaying given how prevalent BPS has become in consumer products”, says Heather Patisaul at North Carolina State University, who was not involved with the study. Patisaul also researches how brain circuits arise and says the Calgary research makes “significant contributions to our understanding of how developmental BPA exposure may impact neural organization and behaviour.”

Like Kurrasch, Patisaul says people need to be aware that “BPA-free” does not mean “chemical-free” or “endocrine disrupter-free” and that products without BPA may have other hormonally active components.

“In terms of a ‘ban,’ I leave those decisions up to the regulators but there is certainly an overwhelming abundance of data suggesting that BPA and BPS are potentially harmful to humans,” says Patisual. She agrees individuals, including pregnant women, who want to limit exposure to BPA, BPS, and chemicals with similar properties should limit contact with receipts and plastics, particularly food and beverage containers.

Dr. Bruce Lanphear, at Simon Fraser University in B.C., said by email the Calgary study is consistent with earlier work indicating that BPA appears to impact brain development.

“I was already convinced the BPA was highly likely to be toxic and unnecessary,” said Lanphear, who is leading a study examining fetal and early childhood exposures to environmental neurotoxins.

“I do think that pregnant women should avoid exposure to BPA and other unnecessary environmental chemicals,” Lanpear said.

Health Canada was asked for comment on the new study but did not respond before deadline.

Twitter.com/margaretmunro

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‘Just say no thank you to receipts’

Within seconds of touching a credit card receipt bisphenol A can be absorbed by the skin. Greasy fingers – from say a French fry as you walk away from the cash register – can increase absorption.

And hand sanitizers, which the author of one recent U.S. study likened to “skin penetration enhancers,” may make it even worse.

“Just say no thank you to receipts” is researcher Deborah Kurrasch’s advice to consumers and pregnant women, whose babies might be at highest risk.

“If I were pregnant I probably wouldn’t take receipts, I’d probably be very careful about plastics and use as much glass as I possibly could,” says the University of Calgary researcher. She is also a mother of eight- and 10-year-olds who does not want to freak mothers out, but does want to educate them.

She says the problem with receipts is that they are often printed on thermal paper that can be coated with BPA, a known endocrine disrupter that has been associated with childhood neurological disorders such as hyperactivity.

While exposure from a single receipt would be very low, she says the dose could add up as use of thermal paper is so ubiquitous.

The BPA that rubs off is quickly absorbed by the skin, getting to a depth where it can’t be washed off, she says.

BPA is part of the process that enables thermal paper to change colour when exposed to heat in credit card terminals, cash registers and ticket dispensers.

In 2010 Environment Canada added BPA to the list of toxic substances in Canada, and in 2012 asked industry to devise plans to reduce release of the substance into the environment.

Environment Canada said Monday it does not have any data on how much thermal paper containing BPA and BPS is used in Canada.

But as part of an voluntary control agreement, the “paper recycling sector agreed to initiate action to minimize the risk of existing environmental impacts from their effluent releases of BPA, where necessary, to the greatest extent practicable,” Danny Kingsberry, an Environment Canada media officer, said in written statement.

The latest data on BPA in Canada’s National Pollutant Release Inventory from 2013 “shows that 3.5 tonnes were sent for off-site disposal, 25 tonnes were transferred for recycling and .001 tonnes were on-site release into the air,” Kingsberry said. He said the department does not collect data on BPS.

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http://o.canada.com/news/national/researchers-advise-pregnant-women-to-limit-exposure-to-receipts-and-plastic/feed5BPA researchmargaretmunroHealth Canada urged to approve abortion pillhttp://o.canada.com/health/health-canada-urged-to-approve-abortion-pill
http://o.canada.com/health/health-canada-urged-to-approve-abortion-pill#commentsMon, 12 Jan 2015 21:19:16 +0000http://o.canada.com/?p=576654]]>A major Canadian medical body is urging Health Canada to approve an abortion pill that would allow a woman to end a pregnancy in the privacy of her own home.

The Society of Obstetricians and Gynaecologists of Canada says allowing Canadian women access to mifepristone would have no impact on the number of women choosing abortion but would help make an “intensely personal issue” a private health matter between a woman and her doctor, said chief executive officer Dr. Jennifer Blake.

Dr. Jennifer Blake, professor of ob/gyn at the University of Toronto and Sunnybrook Health Sciences Centre. [Handout]

Health Canada is expected to decide this month whether to approve mifepristone.

The drug has been under review since 2012. The normal review process is a maximum of 300 days. “Clearly this limit has passed,” said Dr. Joel Lexchin, a professor in the faculty of health at York University in Toronto.

Already in use in more than 50 countries, mifepristone is considered the “gold standard” for medical abortions and is included in the World Health Organization’s list of “essential medicines.”

When combined with the drug misoprostol, mifepristone induces an abortion similar to a natural miscarriage within one to two days after a woman takes the pills.

The drug provides a non-surgical option to abortion and would make abortions safer by allowing them to happen earlier, said Blake, whose organization has supported approval of mifepristone since 2009. It would also help equalize access to abortion in Canada, she said.

“We see this as just something that reduces some of the real additional struggles that women are confronted with (when facing) a pregnancy that is either unplanned or isn’t going well,” Blake said.

Dr. Wendy Norman, chair of the College of Family Physicians of Canada’s section of researchers, said fewer than four per cent of all abortions in Canada are medication abortions, “largely because we don’t have mifepristone available.”

There are no officially approved drugs for medical abortions in Canada. Some doctors prescribe the chemotherapy drug methotrexate “off label” for early abortions. But it is less effective than mifepristone, takes longer to work and can cause serious birth defects if the abortion fails and the woman continues the pregnancy.

“We know throughout the world, and certainly in Canada as well, that the earlier a woman who has an unwanted, unintended pregnancy can access an abortion, the safer it is for her and her ongoing reproductive health,” Norman said.

It hasn’t been shown in any setting that more women have abortions once mifepristone is available, she added.

Instead, a greater percentage of early abortions become medical abortions.

Mifepristone is used in the first seven to nine weeks of pregnancy. The drug blocks the hormone progesterone, which normally helps prepare the lining of the uterus for a pregnancy. The lining breaks down and sheds, similar to what happens during a woman’s menstrual period. Misoprostol causes the uterus to contract, expelling the fetus.

Mifepristone first became available in France and China in 1988. Unlike most new drugs that come on the market, “we have more than 20 years of history on the safety and effectiveness of this drug,” said Dr. Sheila Dunn, of Women’s College Hospital in Toronto.

A review published two years ago in the journal Contraception involving more than 45,000 early abortions with mifepristone found about five per cent of women needed a surgical procedure to complete the procedure. Three in 1,000 women required hospitalization; one in 1,000 required a blood transfusion. The failure rate in terms, of ongoing pregnancy, was one per cent.

“There is a very low incidence of serious side effects with these drugs and they are highly effective in terms of successful abortion, with women not needing any more treatment other than the regimen of the pills,” Dunn said.

Anti-abortion groups are urging Health Canada to keep mifepristone off the market.

“This is an extremely dangerous (drug) for women and is responsible for throwing the natural immune function of the female body into disarray, leading potentially to widespread septic shock,” said Jack Fonseca, of Campaign Life Coalition.

Since the drug’s approval in the U.S., the Food and Drug Administration has received reports of serious adverse events, including several women who died from sepsis, a blood infection.

Health Canada is refusing to say when it expects to make a ruling on mifepristone. “Health Canada does not disclose timelines for specific drug submissions,” the agency said in an email.

Vicki Saporta, of the National Abortion Federation, said the Canadian review has been “the most onerous approval process for this medication in the world.”

The drug has been used by millions of women, she said. “There is no way this drug should not be approved by Health Canada.”

]]>http://o.canada.com/health/health-canada-urged-to-approve-abortion-pill/feed1abortion pillskirkeyDr. Jennifer Blake, professor of ob/gyn at the University of Toronto and Sunnybrook Health Sciences Centre. How smokers metabolize nicotine could predict best way to quit: studyhttp://o.canada.com/health/how-smokers-metabolize-nicotine-could-predict-best-way-to-quit-study
http://o.canada.com/health/how-smokers-metabolize-nicotine-could-predict-best-way-to-quit-study#commentsMon, 12 Jan 2015 14:47:43 +0000https://postmediacanadadotcom.wordpress.com?p=576301&preview_id=576301]]>By Sheryl Ubelacker

THE CANADIAN PRESS

TORONTO — It seems not all smokers are created equal when it comes to how their bodies handle nicotine, and that could have big implications for anyone trying to kick the tobacco habit for good, researchers say.

They based their research on how a smoker metabolizes, or breaks down, nicotine in the liver, using a biomarker called the nicotine metabolite ratio, or NMR. About 60 per cent of smokers are “normalized metabolizers,” while the rest are “slow metabolizers.”

“We’ve shown that it is possible to optimize quit rates for smokers, while minimizing side-effects, by selecting treatment based on whether people break down nicotine slowly or normally,” said Rachel Tyndale, head of pharmacogenetics at the Centre for Addiction and Mental Health in Toronto, who co-led the Canadian-U.S. study.

Normal metabolizers tend to smoke more cigarettes per day and find it harder to butt out because nicotine is eliminated from their bodies much quicker, leading to a shorter duration between cravings for another tobacco rush, she said.

Their slower-metabolizing counterparts tend to maintain a steadier level of nicotine throughout the day and are less sensitive to smoking cues like seeing a cigarette pack, she said, often making it easier to quit.

The study involved 1,246 smokers — 584 normal metabolizers and 662 slow metabolizers — who had sought help to quit and were randomly assigned to receive either a placebo, the skin patch or the varenicline pill. All received behavioural counselling.

Researchers found that normal metabolizers were more than twice as likely to stay off smokes after 11 weeks of taking Champix compared to those on the patch, both by the end of treatment and after six months’ followup. Almost 39 per cent taking the medication were still not smoking after treatment, compared to about 23 per cent of those on the patch.

“Varenicline works very well in normal metabolizers,” she said. “It is a group that responds well to the drug, their side-effect profile is not particularly bad, and it’s an effective drug for them,” she said.

Different methods of quitting smoking can work better or worse, depending on how your body reacts to nicotine. [William Wolfe-Wylie]

The prescription medication works by partially blocking nicotine receptors in brain cells, thereby reducing cravings and withdrawal symptoms. And if someone lapses and has a cigarette, they don’t get the usual boost of feel-good chemicals like dopamine.

“It takes away a little bit of that urge to smoke and it takes away a little bit of their bang for the buck if they do happen to have a cigarette while they’re on it,” she said.

“The interesting thing is that in normal metabolizers, we actually see a decrease in irritability and a decrease in attentional disturbances, so we think this drug is still hitting those nicotinic receptors which have a lot to do with attention, which is why people feel distracted when they don’t have nicotine (in) them.”

However, the study found slow metabolizers benefited more from the patch, all things considered, despite similar quit rates — 28 per cent for the patch, 30 per cent for the pill.

“In the slow metabolizers, we see the patch and varenicline give pretty much the same kind of efficacy … but varenicline costs a lot a more and more importantly, it caused more side-effects in this particular group,” Tyndale explained. Slow metabolizers were more likely to experience nausea and disturbed sleep from abnormal dreams.

“We think that the way the nicotine kinetics changes the receptors in their brain means that they’re much more sensitive to varenicline and it makes it a bit aversive for them.”

Other potential side-effects include headache, drowsiness and altered taste. The drug also carries a “black-box” warning required by Health Canada and the U.S. FDA following a number of reports of depression, aggression and suicidal thoughts and suicide among some people taking varenicline for smoking cessation. In 2011, the regulators added a warning that the drug was linked to a higher risk of heart attack and stroke in people with cardiovascular disease.

“So that would be another reason you only give it to people who benefit from it,” said Tyndale, who nevertheless contrasts the potential harms versus the benefits of the medication in helping people to stop smoking tobacco –which causes 37,000 deaths in Canada each year.

“Overall, you would essentially use a more expensive, more efficacious drug for the 60 per cent who are normal metabolizers, and for the low metabolizers, the patch, which has a very good safety profile and is pretty inexpensive relatively speaking.”

Cigarette butts are the most common type of litter [Robert Neumann, Fotolia.com]

“This is a much-needed, genetically informed biomarker that could be translated into clinical practice,” Lerman said in a release. “Matching a treatment choice based on the rate at which smokers metabolize nicotine could be a viable strategy to help guide choices for smokers and ultimately improve quit rates.”

In a commentary accompanying the study, Jennifer Ware, Neil Davies, and Marcus Munafo of the University of Bristol say the results represent an important scientific advance.

“Should the findings be replicated, they might lead to changes in clinical practice through the implementation of prescriptions stratified on the basis of a biomarker test,” they write. “(However) the extent to which tailoring treatment by a biomarker such as NMR is a cost-effective approach will depend on doing a full health economic assessment … which will also have to consider the effect of warnings stipulated by national regulatory bodies on prescribing rates of varenicline.”

While no commercial NMR test exists outside research labs and hospitals, Tyndale said the U.S. National Institute on Drug Abuse has provided funding to companies to develop a doctors’ test kit, which “we’re hopeful will come along soon.”

The study took water samples from public pools in Georgia and Indiana, and found a host of unlikely contaminants. These included DEET (the active ingredient in insect repellants), flame retardant TCEP and caffeine, as well as traces of common drugs such as ibuprofen, naproxen and acetaminophen. How do they get there? Likely through the sweat and urine of swimmers, while DEET likely comes off their skin. And since many pool systems recycle the same water for long periods of time, these chemicals are essentially allowed to accumulate. Still care to jump in?

A new study suggests there may not be much of a benefit to booking an annual physical with your doctor. [Igor Mojzes/Fotolia.com]

Much like our cars, we book an annual physical with our doctor to make sure everything’s OK, undergo a few routine tests and possibly uncover a problem we weren’t aware of before. But Ezekiel Emanuel argues in the New York Times that these check-ups may essentially be not just a waste of time for ourselves and our doctors; but an unnecessary financial burden on our health care systems, too.

The basis for his controversial claim is a recent study by an international group of medical researchers known as the Cochrane Collaboration. Looking at 14 trials involving 182,000 people over a median of nine years, the study concluded that routine checkups are unlikely to be beneficial. They didn’t reduce mortality among patients, either overall, or for any specific disease. Nor did they typically uncover life-threatening illnesses – or if they did, it was often too late for effective treatment. So while you shouldn’t forego routine screening procedures such as a colonoscopy, going to your doctor may simply be more useful on a needs basis.

Children observed in the 12-year study who displayed signs of pathological guilt were found to have anterior insula with less volume – a characteristic that has already been linked to depression in adults. The study found that the smaller anterior insula in children increased the likelihood that they would suffer clinical depression later in life.

Disneyland has now earned the dubious distinction of being the happiest possible place to contract measles. [Thomas Samson/AFP/Getty Images]

Over the past year, we’ve witnessed a succession of outbreaks of diseases most of us under the age of 40 had only ever read about in old books: measles, mumps, and whooping cough. Weren’t people not supposed to get these illnesses anymore? Hadn’t modern medicine relegated them to the trashbin of history? Well…yes. But lately, the anti-vaccination movement has done a pretty good job of bringing them back. Which brings us to a disheartening piece of news: there has been a measles outbreak at Disneyland.

According to the LA Times, the California Department of Public Health has so far confirmed nine cases of the potentially deadly disease and is investigating another three. The kicker: of the seven confirmed California cases, six hadn’t been vaccinated (although two were too young for the shot). The outbreak comes on the heels of a year in which measles enjoyed a triumphant comeback, fuelled largely by a long-discredited link between the measles vaccine and autism. The CDC reports that 90 per cent of all recent U.S. measles cases were in people who were either not vaccinated or whose vaccination status was unknown.

]]>http://o.canada.com/health/this-week-in-health-dirty-pools-unnecessary-physicals-and-more/feed2tokyo_swimmingpool1024davidkatesA new study suggests there may not be much of a benefit to booking an annual physical with your doctor.Excessive guilt in childhood may be an predictor of depression or other mental illnesses in adulthood.Disneyland has now earned the dubious distinction of being the happiest possible place to contract measles.First trials of Ebola vaccines suggest they are safe; next phase next month: WHOhttp://o.canada.com/health/first-trials-of-ebola-vaccines-suggest-they-are-safe-next-phase-next-month-who
http://o.canada.com/health/first-trials-of-ebola-vaccines-suggest-they-are-safe-next-phase-next-month-who#commentsFri, 09 Jan 2015 14:15:01 +0000https://postmediacanadadotcom.wordpress.com?p=574849&preview_id=574849]]>By Helen Branswell

THE CANADIAN PRESS

The first clinical trial designed to see if two experimental Ebolavaccines actually work may begin in late January and two others are slated to start in February in West Africa, the World Health Organization said Friday.

Manufacturers of the two most advanced experimental vaccines need more time to determine how much vaccine each person might need for the product to work, said Dr. Marie-Paule Kieny, the WHO’s point person for efforts to develop and deploy Ebola vaccines and drugs.

Kieny revealed the news at a press conference in Geneva called to report on a special vaccine summit with manufacturers and researchers that the WHO hosted on Thursday.

Kieny said the two leading manufacturers — GSK and a partnership between NewLink Genetics and Merck — are still analyzing data from small Phase 1 trials of the vaccines that are taking place in a number of sites in the United States, Canada, Europe and several African countries not currently fighting Ebola.

Phase 1 trials are designed to see if a product is safe to use and to determine what the dose for a drug or vaccine should be. They are followed by larger Phase 2 and 3 trials that are designed to show if an experimental product actually works.

It will take the manufacturers another two to four weeks to be able to determine an appropriate dose, Kieny said.

That is a delay on previous plans. It had been hoped the first and the largest of the trials would start in Liberia by mid-January.

The delays in getting the next stage of clinical trials off the ground is raising concerns that the trials may not come up with definitive answers about whether the vaccines work.

In order to show that a vaccine is efficacious, clinical trials vaccinate some people and leave others unprotected. If more cases are seen among those who didn’t get the vaccine, it is signal that the serum is offering protection.

But with the rate of growth of new cases actually falling in many parts of the Ebola outbreak zone, there may not be enough transmission of the virus to be able to show that a vaccine works, some observers fear.

Kieny said the organizers of the Liberian trial are prepared to expand the number of people to be included in the trial if needed. Their statistical analysis suggests they should still be able to reach an answer, she said.

She noted, though, that at this point it seems most likely that a trial planned for Guinea might be the one that will give the earliest clue as to whether the vaccines work.

Two trials are planned for Guinea. One is an observational study, in which health-care workers will be vaccinated. They will be watched to see if new infections among health-care workers drop off after the vaccination.

Another — the one Kieny suggested might show signs of efficacy — involves a design called ring vaccination, in which people who are contacts of known cases will be vaccinated to try to prevent onward transmission.

People in some rings will be vaccinated immediately after a case is identified and others will be vaccinated after a delay. If there are fewer new cases among the contacts who were vaccinated quickly, it would suggest the vaccines are protective.

Kieny said organizers of that trial plan to vaccinate 4,500 contacts quickly and another 4,500 after a delay.

Kieny said a third manufacturer, Johnson & Johnson, indicated it is devising plans to do an efficacy trial of another Ebola vaccine later in the year. The company’s vaccine started Phase 1 testing this week in Britain.

Their vaccine requires two doses, a priming dose followed by a booster some weeks later. That is not an optimal strategy in an outbreak, because of the amount of time it would take to protect people.

But Kieny said there was discussion at the meeting about potentially developing two types of Ebola vaccines, one which could be used to develop immunity quickly in an outbreak setting and another that could be given in advance of exposure to people like health-care workers who might at some point encounter Ebola.

Marie-Paule Kieny, Assistant Director General of the World Health Organization (WHO), informs the media following the second high-level meeting on Ebola vaccines access and financing, during a news conference, at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland, Friday, Jan. 9, 2015. (AP Photo/Keystone,Salvatore Di Nolfi)

08:48ET 09-01-15

]]>http://o.canada.com/health/first-trials-of-ebola-vaccines-suggest-they-are-safe-next-phase-next-month-who/feed2Ebola-Vaccine-Study-20140106.jpgthecanadianpressMarie-Paule Kieny, Assistant Director General of the World Health Organization (WHO), informs the media following the second high-level meeting on Ebola vaccines access and financing, during a news conference, at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland, Friday, Jan. 9, 2015. (AP Photo/Keystone,Salvatore Di Nolfi)Short, intense workouts, functional training among top fitness trends for 2015http://o.canada.com/health/diet-fitness/short-intense-workouts-functional-training-among-top-fitness-trends-for-2015
http://o.canada.com/health/diet-fitness/short-intense-workouts-functional-training-among-top-fitness-trends-for-2015#commentsThu, 08 Jan 2015 14:27:08 +0000https://postmediacanadadotcom.wordpress.com?p=574077&preview_id=574077]]>By Lauren La Rose

THE CANADIAN PRESS

TORONTO — Whether you’re an avid exerciser or seeking to amp up your routine, fitness professionals are pointing to short, intense workouts and back-to-basics strengthening sessions among the hot trends to help you break a sweat in 2015.

In recent years, obstacle course races have proved to be a popular draw among those testing their physical and mental mettle navigating through gruelling boot camp-style exercises littered along the way to the finish line. But for individuals still seeking a challenging workout that is shorter in duration and free of tire-flipping and fire-walking, high-intensity interval training (HIIT) may be a viable option.

Characterized by intense bursts of exercise followed by brief rest periods, HIIT topped the list in canfitpro‘s first national fitness trends survey, which polled nearly 2,000 fitness professionals. Ranking second was functional fitness, described as exercise using movements to prepare individuals “for the activities of daily life.”

“Doing a squat with a barbell across your back is a very functional movement because we do squats all day long, whether it’s getting in and out of a car or sitting down on the toilet or getting out of an office chair,” said Rod Macdonald, vice-president of canfitpro, whose organization bills itself as the largest provider of education in the Canadian fitness industry.

Rhonda Roberts Smid, founder and instructor at TAB Fitness, is pictured in her Toronto studio on Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning. (Photo: THE CANADIAN PRESS/Chris Young)

South of the border, the American College of Sports Medicine ranked HIIT second on its 2015 fitness trends survey, with body weight training — like pushups and pullups — topping their list.

Macdonald said he isn’t surprised to see HIIT topping the Canadian list.

“High-intensity interval training allows the fitness professional to integrate a lot of effective work in a very short period of time which is also appealing obviously to the participant … who maybe doesn’t have a lot of time, or on certain days doesn’t have a lot of time and they still want to get a great workout.”

Macdonald said individuals just starting off with an exercise program should work with a certified fitness professional and be screened for any underlying health issues beforehand. But if they’re in good condition, HIIT is OK provided they’re supervised and go through a full warmup and cooldown, he added.

Vancouver-based fitness instructor Amanda Vogel said in the HIIT class she leads, some participants will opt to go “really hard” in intervals while others adopt a more moderate pace.

“We’re all working together within the framework of what everyone is able to do,” said Vogel.

“I still think there’s a lot of benefit to that because one, they’re moving, which is really important, and anything people are going to enjoy that’s going to get people moving in the right direction of consistent exercise is going to be beneficial.”

Still, Vogel said one potential downside is that participants can sometimes go overboard in terms of frequency. She pointed to the American Council on Exercise which recommends individuals don’t do more than two days of HIIT per week.

“You don’t want to have every day that same kind of very intense workout. You want to be able to vary your workout,” said Vogel, who tests and reviews fitness products and devices as a blogger with Fitness Test Drive.

“So you do some intense, some that are more steady — which might mean at a more moderate pace — and then, of course, even a day or two during the week that’s more of a recovery-based casual walk or something to that effect.”

Women take a TAB Fitness Class in Toronto Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning. (Photo: “THE CANADIAN PRESS/Chris Young)

Rhonda Roberts Smid, founder of TAB Fitness (short for The Art of Balance), places a strong emphasis on mind-body connectivity at her Toronto-based studio, focused on helping participants attain proper alignment and developing a strong core through her classes.

“The arms and the legs, which is usually where you see most of the beauty — your biceps, your triceps, your quads, those types of things — they will not work efficiently if your middle is not working efficiently. So everything usually stems from the middle part of the body and works its way out.”

Roberts Smid said it’s important for people who take on more physically intensive classes to realize they may not necessarily be getting a better workout, and is a proponent of adopting a more moderate approach — particularly for novices.

“I think when you do something that’s very aggressive immediately — because your body is super sore and you see the beauty muscles shining right away — you think ‘Yeah, this class is definitely giving me what I need.’ But underneath all of those beauty muscles is the foundation. And when that is weak it tends to break down quickly, and that is why people are getting injured in a lot of these more intense classes.

“My suggestion to people always is slow turtle. If you’re new to working out don’t throw yourself into the (Tough) Mudder or a half-marathon.”

Regardless of which type of workout they prefer, Macdonald said it’s important that everyone exercises and adopts a regimen best suited to them.

“If somebody’s going to go to the gym and they wouldn’t have otherwise and they’re going to do something that’s moderate or even low-intensity, I would rather that they do that than not go to the gym at all.”

Women take a TAB Fitness Class in Toronto Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning. (Photo: THE CANADIAN PRESS/Chris Young)

]]>http://o.canada.com/health/diet-fitness/short-intense-workouts-functional-training-among-top-fitness-trends-for-2015/feed22015-Fitness-Trends-20150107.jpgthecanadianpressRhonda Roberts Smid, founder and instructor at TAB Fitness, is pictured in her Toronto studio on Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning THE CANADIAN PRESS/Chris YoungWomen take a TAB Fitness Class in Toronto Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning "THE CANADIAN PRESS/Chris YoungWomen take a TAB Fitness Class in Toronto Friday December 19, 2014. TAB Fitness (short for The Art of Balance) places an emphasis on muscular conditioning "THE CANADIAN PRESS/Chris YoungTrying for test-tube baby? Mom’s risks are rare, include over-stimulating ovaries, study sayshttp://o.canada.com/health/sexual-health/trying-for-test-tube-baby-moms-risks-are-rare-include-over-stimulating-ovaries-study-says
http://o.canada.com/health/sexual-health/trying-for-test-tube-baby-moms-risks-are-rare-include-over-stimulating-ovaries-study-says#commentsTue, 06 Jan 2015 19:18:38 +0000http://postmediacanadadotcom.wordpress.com?p=573001&preview_id=573001]]>By Lindsey Tanner

THE ASSOCIATED PRESS

CHICAGO — Complications are uncommon for women undergoing test-tube fertility procedures: A new 12-year U.S. study shows the most frequent involve drugs used to stimulate ovaries, but it suggests problems are rarely fatal.

Over-stimulated ovaries occurred in 154 out of every 10,000 pregnancy attempts; rates of other complications were less than 10 per 10,000 attempts. There were 58 deaths reported during the 2000-11 study. The study lacks information on their causes, and with more than 1 million pregnancy attempts involved, the results are reassuring, said Dr. Jennifer Kawwass, an Emory University assistant professor and the lead author.

The researchers examined federally mandated reports from U.S. fertility clinics.

The fancy term for treatments involved is assisted reproductive technology, the shorthand is IVF. It refers to in vitro fertilization — mixing eggs and sperm in a lab dish. Any resulting embryo or embryos are then transferred to the uterus. A type of IVF involving injecting a single sperm into an egg was included in the study.

Deaths included 18 within 12 weeks of starting fertility drugs — suggesting the drugs might have played a role. The other 40 deaths occurred later, suggesting pregnancy-related complications might have been involved; 18 of these women were carrying twins, triplets or more. The reports don’t list exact causes of death.

Rates for over-stimulated ovaries didn’t change during the study but rates for other medicine side-effects and hospitalizations declined. Stable rates were seen for other problems, including infections, bleeding and anesthesia complications.

Complications were most rare in donors, who typically are healthy young women, and none died.

Doctors in recent years have limited the number of embryos transferred, to reduce chances for unsafe multiple births. Paulson, director of the University of Southern California‘s fertility program, said the move could lead to a decline in some complications including those related to over-stimulated ovaries.

Dr. Jamie Grifo, director of New York University‘s fertility centre, noted that about 2 per cent of U.S. babies are born from IVF, and said the study confirms that risks facing women undergoing the procedure are small.

]]>http://o.canada.com/health/sexual-health/trying-for-test-tube-baby-moms-risks-are-rare-include-over-stimulating-ovaries-study-says/feed0Fertility-Treatment-Risks.jpgtheassociatedpresscanadaVideos of the Year: Putting the Naväge to the testhttp://o.canada.com/news/videos-of-the-year-putting-the-navage-to-the-test
http://o.canada.com/news/videos-of-the-year-putting-the-navage-to-the-test#commentsThu, 01 Jan 2015 17:00:42 +0000http://o.canada.com/?p=570424]]>In 2014 our very own Ishmael Daro set out to answer the question we’ve all been asking: does the Naväge nose cleaner really clean out your nose?

Maybe you played ping-pong as a kid because your parents set up a table in the basement. Maybe you played in high school because you were hanging out with friends at the rec center. And maybe later, you played that other version of pong that requires a table and a ball but no paddles because, you know, you were in college.

You may well have drifted away from the sport since then, but you know what? Your younger self was onto something. Table tennis is an effective — and fun — way to work up a sweat. Your older self might want to try it if you’re looking for a vigorous workout with very little risk of injury. And you might even benefit from the positive effects the sport is widely credited with having on brain functions.

Then there’s Navin Kumar, a 40-year-old government worker who told me, “I’m playing table tennis really for my survival.”

Kumar has gotten back into the sport in a big way recently, despite some pretty major health challenges. The Gaithersburg, Md., resident was born with a congenital heart condition and has undergone five open-heart surgeries, two of them when he was just 3 years old. Now his heart is partially mechanical, with valves made from carbon fibre, and he uses a pacemaker.

On a Caribbean cruise a few years ago, Kumar won a ping-pong tournament (most aficionados refer to it as table tennis, but the more informal term is still acceptable), and he was reminded of how much he had enjoyed the sport as a youngster, even competing in an officially sanctioned event in 1986. He started coming to the Maryland Table Tennis Center in Gaithersburg but then had to take some time off because of some more heart-related issues, as well as the birth of a child.

Since July, Kumar has been back at MDTTC with a vengeance, saying that, “in fact, now I’m playing better because, from a heart standpoint, I’ve had all the open-heart surgeries I need — knock on wood.”

When he first got back into table tennis, Kumar was looking for an energetic but non-contact activity, because of “the mechanical stuff inside” as well as the fact that he takes anticoagulant medicine. He has gotten his cardio level way up, all right, plus some side effects that are proving very helpful in battling an even more pressing medical issue.

About a year and a half ago, Kumar was diagnosed with Parkinson’s disease. He might have gotten that diagnosis sooner, but the onset of symptoms was initally hard to distinguish from the essential tremor (ET) disorder he’d long had.

ET affects the left side of Kumar’s body, while Parkinson’s manifests itself on his right, the side he uses to hold his paddle. During a training session, I saw Kumar ask his coach if he could switch to some drills on the backhand side, because hitting forehands had become temporarily difficult.

Still, the fluidity of his playing “was much worse three months ago,” Kumar told me.

“With the Parkinson’s, I’m getting the added benefit of less muscle stiffness, some improvement in the tremors, as well,” Kumar added. “I’m always going to have the tremors, but at least this helps keep my hands more relaxed.”

Not only that, but in the most recent visit to his neurologist, Kumar showed huge improvement on tests of his motor skills, reflexes and memory.

Navin Kumar, who has a mechanical heart and Parkinson’s disease, practices ping-pong at the Maryland Table Tennis Center in Gaithersburg, Md. He will represent Maryland at the U.S. National table tennis Championships next month.

Table tennis has been linked to improved cognitive function at least as far back as 1992, when Japanese researchers ran tests on frequent players. Their conclusion: “It is evident from this study that table tennis players preserve far better mental ability even in the older age compared with non-players.”

Given a small ball traveling short distances at high speed, players must not only track its movements carefully with their eyes but instantly make strategic decisions and react quickly with their bodies.

“Study after study shows how it helps the brain, it delays the onset of Alzheimer’s,” says Larry Hodges, Kumar’s coach and a co-founder of MDTTC. As for the rest of the body, “you have to move so fast. In a fast rally, you do incredible training. Your legs have to be in great shape, and if you have extra weight, you can’t move.”

At the Northern Virginia Table Tennis Center in Chantilly,Va., head coach Zhongxing Lu pointed out (through his daughter, who translated his Chinese) still more selling points, including table tennis’ ability to improve vision and reflexes, the unlikelihood of serious injury and the almost unlimited age range. His youngest member is 6; his oldest is 82.

Table tennis is certainly a sport one can play well into one’s senior years, if my visit to the Northern Virginia Table Tennis Club in Arlington, Va., was any indication. There, I spoke to three members of the club’s executive board, two of whom were a spry 71, with the third checking in at an even sprier (one presumes) 70.

“Aside from the physical movement, the hand-eye coordination that you develop here is wonderful,” Fred Siskind of McLean, Va., (the 70-year-old) told me. “I thought I would have lost the hand-eye quickness [after many years not playing the sport], and I’m sure I’m not the way I was in my 20s, but I’ve been surprised. . . . The quickness is still there.”

Tom Norwood, also from McLean, added, “This is how I fight off my diabetes. It’s very good exercise. . . . If it weren’t for this, I’d be running on a treadmill somewhere.”

The Maryland center is a state-of-the-art operation, and, according to Hodges, the oldest in the country.

“As of 2007, there were only eight full-time training centers in the United States,” Hodges said. “When we opened in 1992, we were the first. . . . Now there are 76 — we’ve been keeping track.”

Hodges described Maryland as “one of the hotbeds for table tennis,” and MDTTC has long been home to some of the finest table tennis players in the United States, including many national team members.

Kumar is good at table tennis, but he knows he can become much better, and he is excited about his prospects of getting there. In the short term, he is looking forward to competing at the national championships in Las Vegas this month.

Of course, Kumar also has some other major goals in mind.

“I look at my two girls, and I want to be around them forever. I don’t want this Parkinson’s to have its way with me, or even my heart. So I play for my survival.”

]]>http://o.canada.com/health/diet-fitness/up-a-creek-grab-a-paddle/feed1Table tennis is an effective - and fun - way to work up a sweat. Navin Kumar has gotten back into ping-pong in a big way recently, despite some pretty major health challenges.washingtonpostcanadacomNavin Kumar, who has a mechanical heart and Parkinson's disease, practices ping-pong at the Maryland Table Tennis Center in Gaithersburg, Md. He will represent Maryland at the U.S. National table tennis Championships next month.Studies seek to answer if the arts can help the elderly and cognitively disabledhttp://o.canada.com/health/seniors/studies-seek-to-answer-if-the-arts-can-help-the-elderly-and-cognitively-disabled
http://o.canada.com/health/seniors/studies-seek-to-answer-if-the-arts-can-help-the-elderly-and-cognitively-disabled#commentsTue, 30 Dec 2014 15:22:37 +0000http://o.canada.com/?p=569831]]>By Fredrick Kunkle

As rock-and-roll fills a sunny recreation room at Birmingham Green in Manassas, Va., residents of the assisted-living facility seem swept up in the music as if by a powerful wind.

Brett Sigmundsson, 52, belts out the lyrics of a Beatles tune while dancing in place with all the vigor of a middle-aged Mick Jagger. John Archer, 64, rises to his feet in dance. Up front, Norma Felter, 85, a former department store clerk whose eyes are glued to a TV screen showing the lyrics for “Hey Jude,” sings into a microphone, not always in sync with the words but joyfully all the same. Even those whose thoughts appear far away sometimes sway or tap their fingers in time to the beat.

The karaoke session is a popular draw at the facility. But music, art and dance sessions like these are also the subject of intensifying interest among the scientific community.

As the nation’s median age rises and baby boomers retire, the federal government, universities and health-care institutions are seeking to determine whether the arts have a quantifiably therapeutic effect on people with Alzheimer’s disease or other age-related disabilities.

Many researchers agree evidence seems promising that the arts can improve cognitive function and memory, bolster a person’s mood and sense of well-being, and reduce stress, agitation and aggression. But many previous studies have been too limited or poorly designed to say for sure.

The National Endowment for the Arts and the National Institutes of Health and others are pushing for more answers. At Birmingham Green, researchers from George Mason University are conducting a federally subsidized study to examine the impact of the arts on the emotional and cognitive health of older adults.

“There still needs to be a lot of work done,” said Sunil Iyengar, who heads the Office of Research and Analysis at the NEA. Iyengar said research into the effect of art on people with cognitive impairments has suffered from a lack of rigor.

Too many studies lacked proper controls, involved samples that were too small, and were poorly defined. They also may have been looking for the wrong thing, Iyengar said. While searching for hard evidence of biological improvements in memory or cognition, many also overlooked measurable improvements in the mood and well-being of people with Alzheimer’s, and their caregivers, too.

George Moseley, 70, a resident at Birmingham Green in Manassas, Virginia, shows off a mural he painted in a room at the facility. Many researchers agree that there is promising evidence that the arts can improve cognitive function and memory, bolster a person’s mood and reduce stress.

In a paper titled “Shall I Compare Thee to a Dose of Donepezil,” researchers Kate de Medeiros and Anne Basting called for developing research models that would better suit interventions that involve the imagination and meaningful personal experiences, instead of those that have been used to test clinical efficacy of pharmaceuticals.

“I think these are the so-called intangibles that we as a society have tended to underplay,” Iyengar said. “These are really devastating diseases for these people and their families, and anything you can do to reduce that pain is important.”

The National Academy of Sciences, at the request of the NEA and NIH, convened a public workshop in March 2011 to investigate ways to bolster research into arts-related interventions for aging adults. Several studies have hinted at the promise of integrating the arts into therapy for age-related disabilities.

Dance and movement have been shown to help older people avoid falls. Acting sessions can strengthen the sense of social ties and community, a critical need for people whose cognitive impairment can lead to isolation. Interventions using everything from drum circles to poetry have been shown to improve psychological symptoms, such as aggression, in patients with cognitive impairment.

Music has been found to have a particularly strong effect on cognitive function. Research has shown that musical training can help older people distinguish speech better, particularly amid background noise. People recovering from brain injuries, such as a stroke, have been shown to sing words and phrases that they might not otherwise be able to speak. Performing music also relies heavily on memory and understanding of visual and sound patterns. For these reasons, people with musical training may weather the effects of aging better than non-musicians.

“But outside of these things is sheer joy,” said Gary Glazner, founder and executive director of the Alzheimer’s Poetry Project. Glazner said he was working at an adult day-care center in Northern California and searching for ways to connect with people with Alzheimer’s disease when he discovered the power of poetry to reach people with cognitive impairment.

Having studied poetry in college, Glazner shared Henry Wadsworth Longfellow’s poem “The Arrow and The Song” with a resident and from the first line — “I shot an arrow” — hit the mark. Glazner uses poetry, particularly beloved classics learned by older adults, in call-and-response with older people and guides them in writing poems. Jump-rope rhymes, even military cadences, can evoke responses from people with cognitive impairment that engage them, he said.

Holly Matto, a professor of social work at GMU who is conducting the experiment at Birmingham Green, said people with cognitive impairment often feel overwhelmed by their inability to process and integrate information from their surroundings. Using the arts, particularly nonverbal arts such as painting and music, can help restore a sense of organizing their world.

“Those nonverbal ways of communicating are not impaired,” she said.

Her 18-month study, supported in part by a $25,000 grant from the NEA, involves taking groups of 10 randomly assigned people and engaging them in twice-weekly sessions using music, imagery and movement. (There is also a control group.) Those who participate in the study are invited to choose music for the group to listen to and then let their imaginations and memories roam. They also use painting to express what they feel in the music. And they are invited to dance. (Study guidelines forbid observing the study itself, but a reporter was allowed to observe other art programs at the center.)

“The hypothesis is that after folks participate in this study, the people will show an improvement in mood and possibly a change in cognitive function,” Matto said. She said the study subjects and control group are to be evaluated before and after the sessions begin using accepted clinical tools, such as the Profile of Mood States, cognitive assessments and the Geriatric Depression Scale, to evaluate whether the sessions have any lasting impact on the subjects’ mood or well-being.

“It makes me happy,” said Felter, who had been rocking to the Beatles from her wheelchair. She said the music helps her adjust to the stresses of living in a communal setting.

Kathryn Dodd, 65, who lived in Ashburn, Va., before moving to Birmingham Green, said listening to tunes by James Taylor and Mary J. Blige allowed her mind to wander to pleasant memories from years ago.

“Music brings memories. I basically try to remember the good times — I don’t like to dwell on the bad times — and music brings those out,” Dodd said. “I got a lot out of it.”

All over Birmingham Green are visual reminders of the relief art can bring.

George Moseley, 70, who suffers from paranoid schizophrenia, said his love of painting vivid murals of flowers, birds and landscapes — all showing the influence of Thomas Hart Benton and years of formal training at the Corcoran School of Art — has been instrumental in helping manage a lifelong cognitive disability, instead of medication. He describes his art in almost religious terms, saying the activity delivers him from the bondage of his condition.

“It helps me to manage and cope, to have a positive attitude,” he said. “The paintbrush and the art give me an outlook and a feeling of serenity and peace, love, and joy. The paintbrush is the treatment for all else that has failed.”

]]>http://o.canada.com/health/seniors/studies-seek-to-answer-if-the-arts-can-help-the-elderly-and-cognitively-disabled/feed0Sandra Boletchek dances during a karaoke session at Birmingham Green, an assisted-living facility in Manassas, Virginia.washingtonpostcanadacomGeorge Moseley, 70, a resident at Birmingham Green in Manassas, Virginia, shows off a mural he painted in a room at the facility. Many researchers agree that there is promising evidence that the arts can improve cognitive function and memory, bolster a person's mood and reduce stress.On second thought: Mental health still overlooked in Canada, especially behind barshttp://o.canada.com/health/on-second-thought-mental-health-canada-565687
http://o.canada.com/health/on-second-thought-mental-health-canada-565687#commentsMon, 29 Dec 2014 16:00:26 +0000http://o.canada.com/?p=565687]]>With perfect hindsight, Postmedia’s national columnists revisit moments and events they observed in 2014 that deserve a second look. Today, it’s Christie Blatchford on the state of mental health care in Canada.

As December of 2013 ended — with cries for reform to the way the mentally ill are treated and how segregation is used in Canadian prisons — so does this year.

This month marked the year-long anniversary of a coroner’s inquest report into the death of teenager Ashley Smith, who wrapped a final ligature around her neck and died at Kitchener’s Grand Valley Institution on Oct. 19, 2007.

The 19-year-old had spent the better part of her adolescence not only in jails of various sorts but also in segregation — her only friends the guards who rushed in multiple times a day to save her until, under threat of sanctions by management to let her be, one day they didn’t.

The Correctional Service of Canada had a year to formally respond to the sweeping recommendations from that jury, chief among them that prisons stop using solitary confinement as a cure-all.

The CSC replied, in essence, that golly, there are already tight restrictions in place and, the laugh-out-loud line, “decision-makers are held to the highest standards of accountability.”

It is to weep.

Generally, mental health care in Canada is a joke.

In big cities like Toronto and Vancouver particularly, society’s collective responsibility effectively has been downloaded to the police, for whom the mentally ill and unstable account for thousands of encounters a year — occasionally ending in tragedy, whereupon, of course, citizens and professionals alike feel free to pronounce upon police failures.

But nowhere is it worse than in prisons.

Protestors holding a vigil for Ashley Smith in front of Correctional Service of Canada headquarters in downtown Ottawa Monday in 2013. (JULIE OLIVER/OTTAWA CITIZEN)

Many people, like Ashley, who had an anti-social personality disorder, end up in prison precisely because of their illnesses; there, unsurprisingly, they act up; that wins them some time in seg, which makes them only sicker.

It’s a vicious cycle that has been condemned by numerous coroner’s juries in several provinces, the correctional investigator, the agencies which work with inmates, and, oh yes, anyone with half a wit.

The latter group, alas, excludes the dunderheads who run the federal correctional service — and it may be no better within many of the provincial systems. Certainly Ontarians learned this month that a spanking new prison in Toronto still hasn’t got a working sick bay for inmates who are mentally or physically ill: Guess what, they’re put in “medical segregation,” the ultimate oxymoron.

I covered the Ashley Smith inquest for six months in 2013 — readers and editors were begging me to stop — and if someone had asked me at the end of that year what I wished I’d written less about, I would have replied, “Ashley Smith.”

At the end of this one, I can say only that I wished I’d written more about Ashley, and mental health.

Postmedia Newscblatchford@postmedia.com

]]>http://o.canada.com/health/on-second-thought-mental-health-canada-565687/feed3Ashley Smith 20130121christieblatchfordProtestors holding a vigil for Ashley Smith in front of Correctional Service of Canada headquarters in downtown Ottawa Monday in 2013. (JULIE OLIVER/OTTAWA CITIZEN) Videos of the Year: Butterfly child, Jonathan Pitrehttp://o.canada.com/news/videos-of-the-year-butterfly-child-jonathan-pitre
http://o.canada.com/news/videos-of-the-year-butterfly-child-jonathan-pitre#commentsThu, 25 Dec 2014 02:29:16 +0000http://o.canada.com/?p=567894]]>Jonathan Pitre who suffers from an intensely painful, disfiguring skin disease known as Epidermolysis bullosa or E.B. His story and this video went viral in 2014.

]]>http://o.canada.com/news/videos-of-the-year-butterfly-child-jonathan-pitre/feed0butterflychild_voythecanadadotcomAssisted suicide: Canadian Medical Association quietly preparing for ‘all eventualities’http://o.canada.com/news/assisted-suicide-canadian-medical-association-quietly-preparing-for-all-eventualities
http://o.canada.com/news/assisted-suicide-canadian-medical-association-quietly-preparing-for-all-eventualities#commentsSun, 21 Dec 2014 19:55:58 +0000http://o.canada.com/?p=566419]]>The nation’s largest doctors’ group is quietly preparing for possible changes in federal laws governing physician-assisted death, as support among its own members for medical aid in dying grows.

The Canadian Medical Association has consulted medical associations in jurisdictions around the world where euthanasia or assisted suicide is legal to devise possible protocols for Canada if the federal law is changed.

The powerful doctors’ lobby says it would be naïve not to prepare for “all eventualities” as the country awaits a Supreme Court of Canada ruling over whether the federal prohibition outlawing assisted suicide is unconstitutional.

“I think we’re looking at the possibility that the court will refer this back to the lawmakers,” said Dr. Jeff Blackmer, the CMA’s director of ethics.

The Supreme Court could strike down Canada’s ban on assisted suicide and give Parliament one year to craft new legislation, as it did with prostitution.

“They could suggest some framework from the bench that we might want to be in a position to comment on fairly quickly. Or there could be a long period for reflection and committee hearings that we would want to be prepared for,” Blackmer said.

“We’re preparing for all eventualities, and that (a lifting of the ban) is absolutely one of them.”

If there is a change in law, Blackmer said doctors opposed to physician-assisted death “will be looking to us for protection of their conscience and their right not to participate.”

“(Doctors) who do support a change in legislation will be looking to us to help make sure that legislation is crafted in a way that make sense from a medical standpoint,” he said. “Whether or not you agree with this, as a physician, I think you still want to see your medical association at the table when those discussions are happening.”

The organization’s polling shows that 20 to 30 per cent of doctors would be prepared to help terminally ill patients end their lives, should physician-assisted death become legalized, and that a noticeable shift is occurring, with more doctors moving from “undecided” to “pro,” particularly in the area of assisted suicide, Blackmer said.

With assisted suicide, the doctor would prescribe a lethal dose of drugs that patients would take themselves.

Euthanasia means the active termination of a life by the doctor, usually by lethal injection.

The CMA has spent the past year consulting medical associations in Oregon, Washington, Montana, Vermont and New Mexico, U.S. jurisdictions where physician-assisted death is legal, to find out “what has worked, what hasn’t worked and how Canada can learn from those experiences,” Blackmer said.

“We’ve also had long conversations with the Netherlands, Belgium and Switzerland,” he said.

“We’re now in the process of internal consultation and thought processing to look at some of the options and possibilities, to try to come up with a reasonable suggested framework and approach.”

For decades, the CMA’s position on euthanasia was unequivocal: the organization opposed doctor-hastened death in any form. But this summer, the CMA’s general council voted to allow doctors to follow their conscience when deciding whether to participate in medical aid in dying.

In a recent article in the journal HealthcarePapers, Blackmer and past CMA president Dr. Louis Hugo Francescutti said many doctors remain “terrified” by the prospect of a change in federal law.

When a doctor enters a patient’s room, “their purpose is clear: to cure when possible, to care always,” they wrote. “The fact that they might actively hasten the patient’s death does not enter into the equation.”

In an interview, Blackmer said some doctors see aid in dying as an extension of compassionate, end-of-life care.

“And then there are others who say, very clearly, ‘this is not why I became a physician. It was to protect life, to maintain life — certainly to alleviate suffering whenever possible, but not to prematurely end life. That was never part of the deal.’ ”

But, over the past two years, the CMA has held a series of public, as well as doctor-only town hall meetings and online consultations. As doctors learn more about the experiences in other jurisdictions, “more and more doctors are saying, ‘Okay. I feel more comfortable, like there might be a scenario one could imagine where this type of intervention wouldn’t be abused,” Blackmer said.

“Where it would be the really exceptional patient that would need this, and that we could set up some sort of system where we make sure that the vulnerable, and other people are protected, and where physicians have support to participate.’”

Blackmer said it’s a “fool’s game” to try to predict which way the Supreme Court will rule. “But we’re trying to at least look at some of the options that they might have at their disposal.”

He said doctors, and the public, are becoming more comfortable about talking about death and dying “They are not taboo subjects in the same way they were.”

The Supreme Court heard arguments in October over whether the criminal ban on assisted suicide violates the Charter of Rights and Freedoms.

Judgments are normally rendered, on average, six months after a hearing.